Background <p>Hemodialysis (HD) patients are at an increased risk of sarcopenia and related mortality. As the number of elderly patients with chronic kidney disease (CKD) undergoing HD continues to grow, the prevalence of frailty also rises. This study aims to assess whether frailty or sarcopenia constitutes a greater risk to patient survival.</p> Methods <p>A single-center cohort of HD patients was followed for four years. Clinical frailty scores and body composition, assessed using multifrequency bioelectrical impedance analysis, were utilized to evaluate survival outcomes.</p> Results <p>Among 173 HD patients, mean age 64.7 ± 15.6 years, 102 (58.9%) male, 31 (17.9%) diabetic, 66 (38.1%) were sarcopenic, and 132 (76.3%) were frail. Kaplan–Meier analysis revealed no significant differences in survival between patients categorized as non-obese and non-sarcopenic, obese and non-sarcopenic, non-obese and sarcopenic, or obese and sarcopenic. However, frail patients showed significantly higher mortality. Multivariable logistic regression analysis identified frailty as an independent predictor of mortality (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.2–3.6, <i>p</i> = 0.004), while sarcopenia was not statistically significant (HR 1.01, 95% CI 0.83–1.25, <i>p</i> = 0.86).</p> Conclusion <p>Frailty, rather than sarcopenia, was associated with mortality in HD patients. While multifrequency bioelectrical impedance analysis requires specialized equipment, clinical frailty scores offer a rapid and cost-effective screening tool.</p> Graphical abstract <p></p>