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Kidney Week

Abstract: TH-PO673

Peripheral Artery Disease Exacerbates the Prognosis of Frailty in Patients with Hemodialysis

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Takeuchi, Hidemi, Okatyama University, Okayama, Japan
  • Uchida, Haruhito A., Okatyama University, Okayama, Japan
  • Otaka, Nozomu, Okatyama University, Okayama, Japan
  • Umebayashi, Ryoko, Okatyama University, Okayama, Japan
  • Kanai, Hidetoshi, Kokura Memorial Hospital, Kitakyushu, FUKUOKA, Japan
  • Wada, Jun, Okatyama University, Okayama, Japan
Background

The clinical condition of frailty is the most problematic expression of the patients with hemodialysis (HD). The development of frailty is tightly associated with peripheral artery disease (PAD). However, the prognosis of the HD patients with frailty complicated with PAD remains unexplored. The purpose of this study is to identify the influence of PAD on the prognosis of HD patients with frailty.

Methods

We conducted a prospective and multicenter clinical study at 6 institutions. To evaluate the frailty status, we used the modified Fried’s frailty phenotype model. PAD was defined according to the definition of TASC II (Trans-Atlantic Inter-Society Consensus II). Our primary endpoint of this study was the patients’ survival and hospitalization.

Results

Of the 542 patients, 388 HD patients including 82 patients with frailty (21.4%), 204 with pre-frailty (52.6%) and 101 without frailty (26.0%), were enrolled in this study. At baseline, the participants were 67.2 ± 11.9 years of age with more male gender (62.4 %) than female. With an average follow-up period of 24.2 months, a total of 68 patients died; 26.5% of patients with frailty, 17.6% with pre-frailty and 9.9% without frailty. Cox proportional hazards model analyses indicated that frailty was associated with risk of death (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.12–5.23, adjusted for age and gender) and independently associated with the combined outcome of death or hospitalization (HR 2.85, 95% CI 1.74–4.69, adjusted for age, gender and all comorbidities), despite that PAD had no independent association with death and lower risk of the combined outcome. Furthermore, frailty complicated with PAD was independently associated with higher risk of death (HR 4.72, 95% CI 1.37–16.26, adjusted for age, gender and all comorbidities) and the combined outcome (HR 5.89, 95% CI 2.94–11.77, adjusted for age, gender and all comorbidities), compared with frailty only or PAD only.

Conclusion

Frailty itself significantly worsens the prognosis of patients with hemodialysis, and the presence of PAD further exacerbates the prognosis of frail patients with HD.