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
- 1 College of Medicine, National Taiwan University, Taipei, Taiwan
- 2 Department of Medicine, Cardiology Division, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
- 3 Department of Surgery, Cardiovascular Division, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
- 4 Ansn Clinic, Hsin-Chu, Taiwan
- 5 Department of Internal Medicine, Catholic Mercy Hospital, Hsin-Chu, Taiwan
- 6 Hemodialysis Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
- 7 Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
- 8 Quality Control Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu, Taiwan
- 9 Institute of Biomedical Engineering, National Tsing-Hua University, Hsin-Chu, Taiwan
- 10 Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
Received: April 2, 2024 Accepted: November 11, 2024 Published: December 2024
https://doi.org/10.18632/aging.206178How to Cite
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.
Abbreviations
BMI: Body mass index; CVA: Cerebrovascular accident; CI: Confidence interval; CAD: Coronary artery disease; CLTI: Chronic limb-threatening ischemia; DM: Diabetes mellitus; ESRD: End-stage renal disease; HR: Hazard ratio; Hsinchu VA: Hsinchu Vascular Access; IQR: Interquartile range; MALE: Major adverse limb events; PAD: Peripheral arterial disease.