The incidence of frailty among patients with end-stage renal disease (ESRD) is significantly higher than that in the general population, and it is an important risk factor for poor prognosis. Frailty is characterized by a high prevalence rate, multiple mechanism-driven factors, and strong prognostic association in the ESRD population. Its occurrence is the result of the combined effects of demographic characteristics, uremia-specific pathological changes, the nutrition-inflammation-sarcopenia axis, dialysis treatmentrelated factors, and psychological and social factors. In recent years, related studies have focused on key aspects such as chronic low-level inflammation, protein energy wasting (PEW), sarcopenia, loss of residual renal function (RRF), and neuro-endocrine disorders, gradually revealing the complex pathological mechanism involving multiple system interactions. This article reviews the latest research progress on the risk factors of frailty in ESRD patients at home and abroad over the past three years, providing theoretical reference basis for the early screening, risk stratification and precise intervention of clinical frailty.