Chiu-Hui Chen1, Yu-Ling Hsieh2, Shao-Yuan Chuang3, Fan-Yin Su4, Kuan-Ting Wang5, Chien-Ming Luo6,7, Shih-Wei Meng8, Chih-Cheng Wu7,9,10,11. 1. Hemodialysis Center. 2. Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu. 3. Institute of Population Health Science, National Health Research Institutes, Zhunan. 4. Biotechnology R&D Center. 5. Cardiovascular Center. 6. Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu. 7. College of Medicine, National Taiwan University, Taipei. 8. Department of Medicine, Division of Cardiology. 9. Quality Control Center, National Taiwan University Hospital, Hsin-Chu Branch. 10. Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu. 11. Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan.
Abstract
BACKGROUND: Frailty has been associated with mortality and adverse cardiovascular outcomes in patients with hemodialysis (HD), however the relevance of frailty on the outcomes of HD vascular access remains unclear. METHODS: We enrolled a cohort of patients with prevalent HD between August 2018 and November 2018. The presence of 5 frailty phenotypes was determined at enrollment, using the modified Fried's criteria. Data regarding vascular access events or mortality were linked to prospectively collected data up to 24 months after enrollment. RESULTS: Of the 382 patients screened, 313 were recruited in the final analysis. The participants' mean age was 66 years, and 42.5% were female. Among all participants, 40.3% were determined to be frail and 29.4% pre-frail. The frail phenotype was associated with age, female gender, lower body mass index, unemployment, lower education level, and higher dialysis clearance. During the follow-up period (median, 24 months), 112 patients had vascular access events (non-frail, 27.4%; pre-frail, 35.9%; frail, 46.1%; p = 0.003) and 45 patients experienced thrombosis of the vascular access (non-frail, 4.2%; pre-frail, 9.8%; frail, 18.3%; p = 0.002). Cox regression analysis showed that frail patients had a 2.2-fold higher risk of experiencing vascular access events than non-frail patients [hazard ratio (HR): 2.205, 95% confidence interval (CI): 1.377-3.532, p = 0.001], but the association was not significant (HR: 1.634, 95% CI: 0.938-2.848, p = 0.082) after multivariate adjustment. CONCLUSIONS: The frail phenotype is common in Taiwanese patients who undergo maintenance HD and is associated with adverse outcomes of dialysis vascular access.
BACKGROUND: Frailty has been associated with mortality and adverse cardiovascular outcomes in patients with hemodialysis (HD), however the relevance of frailty on the outcomes of HD vascular access remains unclear. METHODS: We enrolled a cohort of patients with prevalent HD between August 2018 and November 2018. The presence of 5 frailty phenotypes was determined at enrollment, using the modified Fried's criteria. Data regarding vascular access events or mortality were linked to prospectively collected data up to 24 months after enrollment. RESULTS: Of the 382 patients screened, 313 were recruited in the final analysis. The participants' mean age was 66 years, and 42.5% were female. Among all participants, 40.3% were determined to be frail and 29.4% pre-frail. The frail phenotype was associated with age, female gender, lower body mass index, unemployment, lower education level, and higher dialysis clearance. During the follow-up period (median, 24 months), 112 patients had vascular access events (non-frail, 27.4%; pre-frail, 35.9%; frail, 46.1%; p = 0.003) and 45 patients experienced thrombosis of the vascular access (non-frail, 4.2%; pre-frail, 9.8%; frail, 18.3%; p = 0.002). Cox regression analysis showed that frail patients had a 2.2-fold higher risk of experiencing vascular access events than non-frail patients [hazard ratio (HR): 2.205, 95% confidence interval (CI): 1.377-3.532, p = 0.001], but the association was not significant (HR: 1.634, 95% CI: 0.938-2.848, p = 0.082) after multivariate adjustment. CONCLUSIONS: The frail phenotype is common in Taiwanese patients who undergo maintenance HD and is associated with adverse outcomes of dialysis vascular access.
Authors: Linda P Fried; Luigi Ferrucci; Jonathan Darer; Jeff D Williamson; Gerard Anderson Journal: J Gerontol A Biol Sci Med Sci Date: 2004-03 Impact factor: 6.053
Authors: Kirsten L Johansen; Lorien S Dalrymple; Cynthia Delgado; George A Kaysen; John Kornak; Barbara Grimes; Glenn M Chertow Journal: Am J Kidney Dis Date: 2014-04-30 Impact factor: 8.860