Outcomes of Radiocephalic Arteriovenous Fistulas (RC-AVFs) in Patients Aged ≥70 Years: The Impact of Frailty on Maturation and Patency

Background Radiocephalic arteriovenous fistulas (RC-AVFs) are preferred for hemodialysis access, but outcomes in elderly patients remain debated. Frailty may influence maturation and patency. Methods This was a retrospective cohort study of patients aged ≥70 years who underwent RC-AVF creation over a 12-month period at a single center. Frailty was assessed using the Clinical Frailty Scale (CFS) and categorized as frail (CFS ≥5) or non-frail (CFS ≤4). The primary outcome was primary failure (failure to achieve functional hemodialysis use during follow-up). Secondary outcomes included patency at three, six, and 12 months and the need for intervention. Logistic regression was used to assess the association between CFS (per one-point increase) and primary failure. Results A total of 52 patients were included (mean age: 75.9 years; 38 {73.1%} male). Primary failure occurred in 23 (44.2%) patients. Frail patients had higher rates of primary failure than non-frail patients (12/20 {60.0%} vs. 11/32 {34.4%}, p=0.090). Each one-point increase in CFS was associated with increased odds of primary failure (OR: 1.87, p=0.013). Patency at three, six, and 12 months was 44 (84.6%), 39 (75.0%), and 29 (55.8%), respectively; 12-month patency was lower in frail patients (4/11 {36.4%} vs. 12/18 {66.7%}, p=0.143). Interventions were required in 17 (32.7%) patients, most commonly angioplasty. Conclusions Frailty was strongly associated with primary failure after RC-AVF creation in patients aged ≥70 years. Incorporating frailty assessment into preoperative evaluation may improve patient selection and counseling, and support shared decision-making.