目的 探讨认知衰弱(cognitive frailty，CF)对老年维持性血液透析(maintenance hemodialysis，MHD)患者动静脉内瘘(arteriovenous fistula，AVF)失功风险的影响。 方法 纳入2023年1─6月于南京医科大学附属明基医院行MHD的≥60岁患者247例，依据衰弱状态及蒙特利尔认知评估量表将患者分为CF组与非CF组。随访至2025年5月31日，每3个月行床旁多普勒超声评估AVF状态，以AVF失功为研究终点事件。采用Kaplan-Meier法和COX比例风险模型分析CF与AVF失功的关系。 结果 CF组患者94例，非CF组153例。2组间年龄(χ²=37.325，P＜0.001)、性别(χ²=4.029，P=0.045)、婚姻状况(χ²=8.365，P=0.004)、个人平均月收入(χ²=12.717，P=0.002)、文化程度(χ²=11.974，P=0.003)、透析龄(χ²=7.283，P=0.026)、原发病(χ²=13.654，P=0.003)、规律锻炼(χ²=45.527，P＜0.001)、血磷(χ²=15.401，P＜0.001)、白蛋白(t=4.887，P＜0.001)、前白蛋白(t=6.741，P＜0.001)、血红蛋白(t=2.770，P=0.006)比较差异有统计学意义。中位随访29.7(29.5，30.2)月，共发生AVF失功64例，其中CF组37例(39.4%)，非CF组27例(17.6%)。Kaplan-Meier分析显示：CF组患者AVF失功风险高于非CF组(χ²=14.302，P＜0.001)，进一步采用COX比例风险模型对混杂因素进行校正，结果显示CF是AVF失功的独立危险因素(HR=2.015，95% CI：1.106～3.670，P=0.022)，即使在校正基线资料后该效应仍存在。 结论 CF可独立增加老年MHD患者AVF失功风险，可作为血管通路风险评估和护理干预的参考指标。

Objective To investigate the effect of cognitive frailty (CF) on the risk of arteriovenous fistula (AVF) dysfunction in elderly patients undergoing maintenance hemodialysis (MHD).  Methods A total of 247 patients aged ≥60 years and received MHD at BenQ Medical Center Affiliated to Nanjing Medical University from January to June 2023 were enrolled in this study. According to cognitive status and Montreal Cognitive Assessment scores, patients were divided into CF group (n=94) and non-CF group (n-153). Patients were followed up until May 31, 2025. Bedside Doppler ultrasound examination was performed every 3 months to evaluate AVF status, with AVF dysfunction as the endpoint event. Kaplan-Meier method and COX proportional hazards model were used to analyze the relationship between CF and AVF dysfunction.  Results There were statistically significant differences in age (χ²=37.325, P<0.001), gender (χ²=4.029, P=0.045), marital status (χ²=8.365, P=0.004), average monthly personal income (χ²=12.717, P=0.002), educational level (χ²=11.974, P=0.003), dialysis vintage (χ²=7.283, P=0.026), primary disease (χ²=13.654, P=0.003), regular exercise (χ²=45.527, P<0.001), serum phosphorus (χ²=15.401, P<0.001), albumin (t=4.887, P<0.001), prealbumin (t=6.741, P<0.001), and hemoglobin (t=2.770, P=0.006) between the two groups. The median follow-up duration was 29.7 (29.5, 30.2) months. A total of 64 cases with AVF dysfunction were detected, including 37 cases (39.4%) in the CF group and 27 cases (17.6%) in the non-CF group. The risk of AVF dysfunction was significantly higher in the CF group than in the non-CF group (Log-rank, χ²=14.302, P<0.001). After adjusting confounding factors using the COX proportional hazards model, CF was identified as an independent risk factor for AVF dysfunction (HR=2.015, 95% CI: 1.106～3.670, P=0.022), and the effect  of CF remained after further adjustment of baseline characteristics.  Conclusion CF independently increases the risk of AVF dysfunction in elderly MHD patient, which can serve as a reference indicator for the assessment and nursing intervention of AVF dysfunction risk.