Frailty is common in hemodialysis paitents. We reported low skeletal muscle fraction is an independent risk factor of intradialytic hypotension. Biomarker study of long-term mortality among frail populations is essential for patient risk classification and as a prognosticator marker. Total 146 adult patients undergoing maintenance hemodialysis were analyzed in this study. Blood collection, clinical/laboratory data, and bioimpedance measurements were conducted simultaneously. As an ad-hoc study of previous observational cohort, mortality and major cardiovascular events (MACE) were collected retrospectively. Proteomes were measured in unsupervised way by liquid chromatography-tandem mass spectrometry, and selected by least absolute shrinkage and selection operator method. Literature based four biomarkers (IL-6, P3NP, TNF-alpha, myostatin) were additionally measured. Average follow-up period was 4.8 ± 2.4 years. Mortality occurred in 35 cases (24%). MACE occurred in 37 patients (25%). In multivariable analysis, several clinical risk factors were statistically significant (reported as variable name; hazard ratio (95% confidence interval): age (1 yr); 1.082 (1.040–1.123), female sex; 0.234 (0.083–0.659), height adjusted muscle mass (1 kg/m2); 0.324 (0.192-0.548), stroke history; 0.122 (0.025 – 0.592), nt-proBNP (1000 ng/mL); 1.047 (1.008-1.087), intact PTH (100 pg/mL); 1.215 (1.017-1.451). In the multivariable competing risk model, IL-6 was shown subdistribution hazard ratio to MACE as 6.425 (1.508 – 27.382). C-statistics of clinical prediction model to patient mortality was modest as 0.758 (0.671 – 0.845) (Table 1). When selected three peripheral blood biomarker were added to clinical variables to predict patient mortality, c-statistics was 0.781 (0.697 – 0.865) and net reclassification index was increased by 0.880 (0.127 – 1.257) In among prevalent hemodialysis patients, age, male sex, low muscle mass, high nt-proBNP, and high PTH are significant risk factors. In addition to clinical parameters, IL-6 was significant risk factor for MACE in competing risk model. Three biomarker panel added net reclassification index when added to clinical prediction model.