Abstract: Objective  This study explored the relationship between maturation failure of autologous arteriovenous fistula (AVF) and frailty in elderly maintenance hemodialysis (MHD) patients to provide a basis for planning vascular access and intervention in frailty patients.  Methods  A total of 275 elderly patients undergoing AVF surgery in a hospital in Shanxi province from January 2020 to December 2023 were investigated. Propensity score matching (PSM) was used to control confounding factors, post-matching univariate analysis was performed, and then modified Poisson regression analysis was applied for effect estimation.  Results  The survey showed that the incidence of maturation failure was 27.3% and frailty was 35.6% in elderly MHD patients. Univariate analysis after PSM showed that the incidence of maturation failure in frail patients was significantly different compared to the non-frail patients (χ2=9.341, P=0.002). After controlling for other confounding factors by modified Poisson regression analysis, it was further concluded that frailty (RR=1.921, 95% CI:1.302～2.835, P=0.001) was an independent risk factor for AVF maturation failure.  Conclusion  The incidence of preoperative frailty was higher in elderly MHD patients. The risk of AVF maturation failure in frail patients was 1.9 times higher than that in non-frail patients. To provide a basis for long-term vascular access decision-making and intervention, comprehensive evaluation of the elderly before AVF surgery should be emphasized.

Key words: Elderly, Hemodialysis, Frailty, Autologous arteriovenous fistula, Maturation failure