Development and validation of a nomogram for identifying the risk of oral frailty in middle-aged and elderly patients undergoing maintenance hemodialysis: a cross-sectional study

Abstract

Oral frailty is a common subtype of frailty that is closely related to sarcopenia, malnutrition, disability, etc. However, it is often overlooked in maintenance hemodialysis (MHD) patients. Currently, research on oral frailty in MHD patients is still limited. This study aims to develop a nomogram to estimate the probability of current oral frailty in middle-aged and elderly MHD patients. From September 2025 to December 2025, using the convenience sampling method, 504 middle-aged and elderly MHD patients who were admitted to 4 tertiary grade A general hospitals’ hemodialysis centers in Sichuan Province, China, were selected as the research subjects. Through univariate analysis and logistic regression analysis, the influencing factors of oral frailty in middle-aged and elderly MHD patients were screened. A nomogram model was drawn using R software, and internal validation was conducted using the Bootstrap method. The predictive ability of the model was evaluated by methods such as the area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow (H-L) test, calibration curve, and decision curve analysis (DCA). The prevalence of oral frailty in middle-aged and elderly MHD patients was 39.3%. The results of logistic regression analysis showed that age, marital status, chronic oral pain, frequent dry mouth, subjective chewing difficulty, physical frailty, social isolation, depression, and social support were the influencing factors for oral frailty in middle-aged and elderly MHD patients. The area under the ROC curve of the nomogram model was 0.920 (95% CI: 0.892–0.947), with a sensitivity of 0.828, a specificity of 0.928, and an accuracy of 0.889. The calibration curve, Brier score, and H-L test results all indicated that the predictive accuracy of this model was good. This study successfully developed and validated a nomogram for identifying oral frailty in middle-aged and elderly MHD patients, which demonstrated excellent model performance in cross-sectional classification. The use of this tool enables effective screening of oral frailty in middle-aged and elderly MHD patients. However, these findings should be considered preliminary, and external validation in independent populations is required before the model can be recommended as a screening tool in clinical practice.