Frailty and outcomes of vascular access for hemodialysis – a scoping review
DOI:
https://doi.org/10.48750/acv.613Keywords:
Renal Dialysis, Frailty, Dialysis Access, Chronic Kidney DiseaseAbstract
INTRODUCTION: Frailty is an age-related condition related to the decline of physiologic capacity and the increased vulnerability to stressors. It is associated with increased mortality, hospitalizations, and healthcare costs. Dialysis patients, due to age and comorbidities, are especially vulnerable to frailty. The aim of this review was to assess the impact of frailty on outcomes of vascular access for haemodialysis.METHODS: A search was conducted on PubMed, Scopus and Cochrane to identify articles reporting on frailty and outcomes of vascular access in dialysis patients.
RESULTS: A total of seven studies were included. Patients included ranged from 40 to 41471, and frailty prevalence ranged from 24 to 53%. There was considerable heterogeneity in frailty assessment. Three studies reported higher mortality in frail patients. Frailty was also associated with recurring vascular access failure, higher risk of non-maturation and access thrombosis in included studies. Higher perioperative complications in frail patients were also reported.
CONCLUSION: Frailty is associated with adverse outcomes of vascular access in dialysis patients, including thrombosis, longer time to functional use of access, and reintervention. Frail patients also have higher mortality after vascular access construction when compared to non-frail patients. Frailty assessment might be a valuable tool in shared decision-making regarding vascular access in dialysis population.
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References
Hoogendijk EC, Affalco J, Ensrud KE, Kowal P, Onder G, et al. Frailty implications for clinical practice and public health. Lancet. 2019;394:1365-75.
Alvarez-Bustos A, Rodriguez-Sánchez B, Carnicero-Carrerio JA, Sepúlveda-Loyola W, Garcia-Garcia FJ, Rodriguez-Mafias L. Healthcare cost expenditures associated to frailty and sarcopenia. BMC Geriatr. 2022;22:747.
Almohansen N, Cittins M, Todd C, Sremanakova J, Sowerbutts AM, Aldossari A, et al. Prevalence of Undernutrition, Frailty and Sarcopenia in Community-Dwelling People Aged 50 Years and Above: Systematic Review and Meta-Analysis. Nutrients 2022;14:4.
Fried LD, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. Journal of Gerontology Series A Biological Sciences and Medical Sciences. 2001;56:14146-56.
Rockwood K, Minnitsi A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62:722-7.
Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive genetic assessment. Journal of the American Geriatrics Society. 2004;45:2928-33.
Formosa V, Lotusso G, Lentini G, Terracciano E, Gentili S, Liotta G. Multidimensional Short Tools to assess frailty: a narrative review. Ann Ig. 2023;352:133.
Welsh SA, Pearson RC, Hussey K, Brittenden J, Orr DJ, Quinn T. A systematic review of frailty assessment tools used in vascular surgery research. J Vasc Surg. 2023;78:1567-79.
Lee HJ, Son YJ. Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18:10.
Guo Y, Tian R, Ye PJ. Luo Y. Frailty in Older Patients Undergoing Hemodialysis and Its Association with All-Cause Mortality: A Prospective Cohort Study. Clin Interv Aging. 2022;17265-75.
Tonelli M, Wiebe N, Gill JS, Bello AK, Hemmelgarn BR, Chan CT, et al. Frailty and Clinical Outcomes in Patients Treated With Hemodialysis: A Prospective Cohort Study. Kidney Med. 2023;5100684.
Santos D, Ferreira LCS, Pallone JM, Ottaviani AC, Santos-Orlandi AA, Pavarini SCJ, et al. Association between frailty and depression among hemodialysis patients: a cross-sectional study. Sea Paulo Med J. 2022;140:4061.
Kim HJ, Lee H, Kim DK, Oh KH, Kim YS, Ahn C, et al. Recurrent Vascular Access Dysfunction as a Novel Marker of Cardiovascular Outcome and Mortality in Hemodialysis Patients. Am J Nephrol. 2016;447-B0.
Wu CK, Lin CH, Hsu CC, Tarno DC, Kor CT, Chen YC, et al. Association of early loss of primary functional patency of arteriovenous access with mortality in incident hemodialysis patients: A nationwide population-based observational study. Medicine (Baltimore). 2018;97:e1f630 .
Lin HC, Cai ZS, Huang JT, Chen MJ. The correlation between frailty and recurrent vascular access failure in the elderly maintenance hemodialysis patients. International Journal of Gerontology. 2020;141:59-62.
Wei Y, Cao Y, Yang X, Xu Y. Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Medicine (Baltimore). 2018;97:e0581 .
Woo K, Gascue L, Norris K, Lin E. Patient Frailty and Functional Use of Hemodialysis Vascular Access: A Retrospective Study of the US Renal Data System. Am J Kidney Dis. 2022;80:30-45.
Chen CH, Hsieh YL, Chuang SY, Su FY, Wang KY, Luo CM, et al. The Impact of Frailty on the Outcomes of Hemodialysis Vascular Access. Acta Cardiol Sin. 2022;382:9-38.
Luo CM, Hsieh MY, Cheng CH, Chen CH, Liao MT, Chuang SY, et al. Association of Frailty With Thrombosis of Hemodialysis Vascular Access: A Prospective Taiwanese Cohort Study. Am J Kidney Dis. 2022;80:353-63.
Stavert B, Monaro S, Naganathan V, Atiken S. Frailty predicts increased risk of reintervention in the 2 years after arteriovenous fistula creation. J Vasc Access. 2023;241:428-37.
Gilbert T, Neuburger J, Krainicler J, Keeble E, Smith P, Ariri C, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018;391:775-82.
McDonnell SM, Nikfar S, Blecha M, Halandras PM. Frailty screening for determination of hemodialysis access placement. J Vasc Surg. 2024;79:91-7.
Wang KM, Gelabert H, Jimenez JC, Ripberg D, Woo K. Short-term mortality and revisions to promote maturation after arteriovenous fistula creation. J Vasc Surg. 2024;79:98-24.
Rothenberg KA, George EL, Barreto N, Chen R, Samson K, Johanning JM, et al. Frailty as measured by the Risk Analysis Index is associated with long-term death after carotid endarterectomy. J Vasc Surg. 2020;72:1755-42.
Johansen KL, Dalrymple LS, Glidden D, Delgado C, Kaysen GA, Grimes B, et al. Association of Performance-Based and Self-Reported Function-Based Definitions of Frailty with Mortality among Patients Receiving Hemodialysis. Clin J Am Soc Nephrol. 2016;11:626-32.
Kojima G. Prevalence of frailty in end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol. 2017;49:1989-97.
Theou O, O'Connell MD, King-Kallimanis BL, O'Halloran AM, Rockwood K, Kenny RA. Measuring frailty using self-report and test-based health measures. Age Ageing. 2015;44:47-17.
Cobbers RJ, van Assen MA. Frailty and its prediction of disability and health care utilization: the added value of interviews and physical measures following a self-report questionnaire. Arch Gerontol Geriatr. 2012;553:69-79.
Old R, Hamasaki Y, Tsuji S, Suzuki K, Tsunetshi S, Imatuku M, et al. Clinical frailty assessment might be associated with mortality in incident dialysis patients. Sci Rep. 2022;121:7651.
Sy J, McCulloch CE, Johansen KL. Depressive symptoms, frailty, and mortality among dialysis patients. Hemodial Int. 2019;23:239-46.
King SJ, Reid N, Brown SJ, Brodie LJ, Sia Abri, Chatfield MD, et al. A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease. BMC Geriatr. 2023;236:64.
Kennard A, Glasgow N, Rainstrod S, Talauilkar G. Frailty in chronic kidney disease: challenges in nephrology practice. A review of current literature. Intern Med J. 2023;53:465-72.
Brahmbhatt A, Bernuzzi A, Franzoni M, Misra S. The molecular mechanisms of hemodialysis vascular access failure. Kidney Int. 2016;89:303-16.
Mutewelk-Turkovic A, Resic H, Roljic B, Devršević A, Bedragić A. The frailty phenotype in hemodialysis patients and its association with biochemical markers of mineral bone disorder, inflammation and nutrition. Rom J Intern Med. 2022;604:2-8.
Lok CE, Huber TS, Lee T, Shenoy S, Vezzlin AS, Abreo K, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75:S1-S164 .
