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Research Paper|Volume 16, Issue 22|pp 13676—13692

Association of frailty and chronic limb-threatening ischemia in patients on maintenance hemodialysis: a prospective cohort study

Mu-Yang Hsieh1,2, Chien-Ming Luo3, Chi-Hong Cheng4, Li-Pei Dai5, Chiu-Hui Chen6, Shao-Yuan Chuang7, Chung-Wei Yang1,6, Chih-Cheng Wu2,8,9,10
  • 1College of Medicine, National Taiwan University, Taipei, Taiwan
  • 2Department of Medicine, Cardiology Division, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
  • 3Department of Surgery, Cardiovascular Division, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
  • 4Ansn Clinic, Hsin-Chu, Taiwan
  • 5Department of Internal Medicine, Catholic Mercy Hospital, Hsin-Chu, Taiwan
  • 6Hemodialysis Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
  • 7Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
  • 8Quality Control Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
  • 9Institute of Biomedical Engineering, National Tsing-Hua University, Hsin-Chu, Taiwan
  • 10Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
Received: April 2, 2024Accepted: November 11, 2024Published: December 31, 2024
https://doi.org/10.18632/aging.206178

Copyright: © 2024 Hsieh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Chronic limb-threatening ischemia (CLTI) is a prevalent yet unpredictable complication among patients undergoing hemodialysis, and frailty is linked to adverse outcomes in this population. This study examined the influence of clinical factors on vascular events in patients undergoing hemodialysis. This multicenter prospective cohort study included patients undergoing maintenance hemodialysis since January 2008. The initial cohort consisted of 1,136 patients, 828 of whom successfully underwent a frailty test. CLTI events were recorded at 3-month intervals until December 31, 2022. The mean patient age was 67 years, and 48% were female. Overall, 34% of participants were frail, 38% pre-frail, and 28% not frail. Frailty phenotype was associated with age, female sex, low educational level, diabetes mellitus, and history of stroke. During a median follow-up of 1461 days, 104 patients experienced CLTI events (not frail, 6.5%; pre-frail, 11%; frail, 20%; P < 0.001). Frail patients had a higher risk of CLTI than those who were non-frail (hazard ratio (HR) 3.94; 95% confidence interval (CI) 2.22–6.99; P < 0.001). After multivariable adjustment for age and comorbidities, frailty remained significantly associated with CLTI (HR 3.26; 95% CI 1.76–5.85; P < 0.001). Conclusively, these findings highlight the risk of CLTI in frail patients undergoing hemodialysis.