Frailty is associated with vascular thrombosis events in chronic hemodialysis patients

Abstract

Abstract Background Frailty is common in chronic hemodialysis patients and is associated with increased risk of mortality. In hemodialysis patients, cardiovascular disease is the most cause of mortality but the impact of frailty on cardiovascular disease remained unknown. Purpose To access if there was an association between frailty and vascular thrombotic events among chronic hemodialysis patients. Methods This is a multi-center cohort study of chronic hemodialysis patients conducted since Jan, 2018 (last follow-up in December, 2020). Baseline data were collected from medical records and hemodialysis records. Frailty was defined by the Fried's criteria, a composite construct that incorporated poor physical functioning, exhaustion/fatigue, low physical activity, and undernutrition using a self-reported questionnaire. The primary outcome was vascular thrombosis events, defined as myocardial infarction, ischemic stroke, acute or critical limb ischemia, and dialysis vascular access thrombosis. The outcomes were assessed from a prospectively-collected nationwide registration system which was updated every 3 months and verified after review of medical records or discussion with caring physicians. Results During the study period, 571 chronic hemodialysis patients were enrolled. The mean age of study participants was 66 years old (SD, 13) and 55% of them were male. A total of 247 patients (43%) were categorized as frail. At baseline, logistic regression analysis revealed that older age, female sex, diabetes, low albumin and history of stroke were independently associated with frailty. During the follow-up period (median, 18 months), 57 patients (10%) died and 182 patients (31.9%) had vascular thrombosis events, including 101 arterial thrombosis (17.7%) and 105 dialysis access thrombosis (18.4%). In the primary outcome analysis, Cox proportional hazards modeling indicated that frailty was independently associated with vascular thrombosis events (Hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.132–2.597). In the secondary analysis, frailty was associated death (HR 2.25, CI 1.16–4.37), arterial thrombosis events (HR 1.92, CI 1.16–3.18), and dialysis vascular access thrombosis events (HR 1.90, CI 1.24–2.91). Conclusion Frailty phenotype is extremely common in hemodialysis patients. It is associated with mortality and vascular thrombosis events among chronic hemodialysis patients. Given its prevalence and consequence, research focus on interventions aimed to prevent or attenuate frailty in hemodialysis patients should be warranted. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Grants from National Taiwan University Hospital, Hsinchu Branch.