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

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%; <i>P</i> < 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; <i>P</i> < 0.001). After multivariable adjustment for age and comorbidities, frailty remained significantly associated with CLTI (HR 3.26; 95% CI 1.76-5.85; <i>P</i> < 0.001). Conclusively, these findings highlight the risk of CLTI in frail patients undergoing hemodialysis.