This study using USRDS data assessed the relation between dialysis initiation and frailty. The prevalence of frailty was 73% among the participants. Multivariate analysis showed that higher eGFR at dialysis initiation was associated with higher odds of frailty. Furthermore, frailty was independent associated mortality and time to first hospitalization while eGFR was not. Clinicians need to be aware of the signs and symptoms of frailty as it may prompt earlier dialysis starts and may explain the increased mortality seen in the population.