Frailty correlates with longer times to vascular access functional use
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Patients with a higher degree of frailty are more likely to experience a longer wait time for fistula and graft functional use after dialysis initiation, according to data published in the American Journal of Kidney Diseases.
“Frailty is associated with a more than twofold increase in [1]-year mortality among patients with end-stage kidney disease and an increased risk of postoperative morbidity and mortality in patients undergoing oncologic, neurologic, colorectal, orthopedic and vascular operations,” Karen Woo, MD PhD, of the division of vascular surgery in the department of surgery at David Geffen School of Medicine, University of California, Los Angeles, and colleagues wrote. “Despite the high prevalence of frailty among dialysis patients, it is unknown whether frailty is associated with dialysis vascular access failure. This study examined the association between frailty and vascular access outcomes.”
In a retrospective observational study, researchers followed patients who started dialysis and had information in the United States Renal Data Systems (USRDS) database between Jan. 1, 2021, through Oct. 31, 2015.
Using Fine and Gray competing risk models, researchers measured fistula and graft outcomes. Additionally, the “claims-based frailty indicator” (CFI) was determined using a validated claims-based disability status model connected to a well described frailty phenotype. Participants were categorized into quartiles of frailty based on the CFI.
The primary outcome of this study was considered time to functional use for fistulas and grafts.
Among the 41,471 patients who met inclusion criteria, 33,212 received a fistula and 8,259 received a graft after initiating dialysis. Researchers found 57% of patients who underwent fistula creation achieved function use of the fistula during the observation period, whereas 68% of the graft group achieved function use of the graft.
Those in higher quartiles of the CFI correlated with a greater rate of mortality. Analyses revealed the highest quartile of CFI was “significantly associated” with longer time to fistula and graft functional use.
“Our findings demonstrated that patients who were most frail had a significantly lower likelihood of successfully using of a fistula compared to the patients who were least frail. Patients who were most frail were also at the highest risk of mortality, suggesting that patients who are most frail may not derive benefit from placement of an arteriovenous fistula,” Woo and colleagues wrote. “Frailty, if measured in a systematic clinical assessment, could be used to guide vascular access decision-making and future studies of vascular access outcomes should include assessment of frailty. Efforts to identify an effective predictive model of fistula maturation failure should be continued.”
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