The Correlation between Frailty and Recurrent Vascular Access Failure in the Elderly Maintenance Hemodialysis Patients

Background: Frailty is highly prevalent among the dialysis population and recent studies suggest that frailty affects dialysis outcomes such as vascular access failure (VAF). This study aimed to explore the correlation between frailty and one year recurrent VAF among the elderly. Methods: A retrospective review enrolled the medical records for dialysis patients over 60 years of age who were first diagnosed with VAF and received angioplasty. Demographic data, arteriovenous fistula functions (vascular access blood flow) and dialysis efficiency calculated based on Kt/V calculator were analyzed. Frailty was assessed using the FRAIL scale which includes 5 components: fatigue, resistance, ambulation, illness, and weight-loss. Patients with FRAIL scale (3-5) were categorized into frail. Results: A total of 73 records for elderly patients (mean age 68.8 +/- 3.2 years; 56% male) were evaluated. The mean dialysis period for patients was 9.1 +/- 7.3 years and 20 patients (27.4%) were previously diagnosed as frail in status. After one year of enrollment 25 (34.2%) patients experienced recurrent VAF required repeated percutaneous transluminal angioplasty or thrombectomy. Multivariate regression analysis indicated that age increased the risk of recurrent VAF during one year follow up (odd ratio [OR) 1.106, 95% confidence interval 1.029-1.190, p = 0.008), fatigue increased the risk of recurrent VAF (odd ratio [OR) 7.597, 95% confidence interval 1.411-40.833, p = 0.018) and loss of weight (odd ratio [OR) 4.803, 95% confidence interval 1.164-19.805, p = 0.030). Conclusion: We assert that age, fatigue, and weight loss are useful prognostic indicators for the identification of recurrent VAF. Timely and regular assessment of frailty may allow for interventions that could mitigate potentially VAF. Copyright (C) 2020, Taiwan Society of Geriatric Emergency & Critical Care Medicine.