Frailty is associated with increased risk for upper arm arteriovenous fistula abandonment

The autogenous arteriovenous fistula (AVF) is the gold standard for hemodialysis access but can be limited by time to maturation. Frailty may affect AVF use in patients with end-stage renal disease. This study aims to evaluate the impact of frailty, as measured by a concise comorbidity-based tool, on AVF maturation outcomes.

A retrospective chart review of patients with upper arm AVFs created at an academic tertiary referral center over a 2-year period (January 2022-December 2023) was performed. Frailty was measured using the five-factor modified frailty index (mFI-5). A composite "poor outcome" was defined as AVF abandonment due to non-maturation, excessive (≥3 unplanned) reinterventions to achieve maturation, or mortality prior to AVF maturation. Additional outcomes included non-maturation within 3 months and non-maturation within 6 months. Multivariable logistic regression models evaluated for associations between frailty and each outcome while adjusting for preoperative characteristics.

The cohort included 122 patients (mean age, 66 ± 12 years; 44% women; 42% Black). Of these, 50% were severely frail (mFI-5 score ≥3). Overall incidence of the composite poor outcome was 21%. Patients who experienced the composite poor outcome were more likely to have chronic obstructive pulmonary disease (35% vs 13%; P = .018), higher frailty score (3.2 ± 0.9 vs 2.4 ± 1.1; P = .001), and severe frailty (69% vs 45%; P = .047). On multivariable analyses, higher frailty was associated with increased risk for the composite poor outcome (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.30-4.26), which was driven by increased risk for AVF abandonment due to non-maturation (OR, 3.24; 95% CI, 1.48, 9.09). Frailty was not associated with 3-month and 6-month maturation outcomes (P > .05). Black race was associated with increased risk for failure of unassisted maturation within 3 months (OR, 2.79; 95% CI, 1.06-7.83). No sex differences were found in the composite poor outcome or maturation outcomes.

Among patients with newly created upper arm AVFs, higher frailty was associated with increased risk for AVF abandonment. Patients with severe frailty may be less likely to benefit from AVF creation.