Prognostic value of the Hospital Frailty Risk Score (HFRS) and outcomes in peripheral artery disease and end-stage kidney disease

Background: Peripheral artery disease (PAD) and end-stage kidney disease (ESKD) are independent risk factors affecting outcomes like in-hospital mortality. The role of a frailty index in prognosticating outcomes in patients with ESKD and PAD is unknown. We aim to assess the prognostic value of the Hospital Frailty Risk Score (HFRS) and its association with outcomes in these patients. Methods: We identified patients with PAD using data from the United States Renal Data System (USRDS) for the years 2015–2018. These patients were stratified into three categories of frailty risk based on their HFRS, a validated frailty assessment tool using ICD-10 codes: low (< 5), intermediate (5–10), and high risk (> 10) and based on revascularization or not. Primary outcomes included in-hospital mortality and composite of mortality or major amputation. Secondary outcomes encompassed postdischarge mortality and composite of mortality or major amputation at 1 year. Results: Out of 122,649 patients with PAD and ESKD, 4118 underwent revascularization and 118,531 did not. In-hospital outcomes demonstrated a nonlinear relationship and postdischarge outcomes displayed a nearly linear relationship with HFRS, regardless of revascularization status. In both cohorts, the high-risk group was associated with a significantly higher risk of in-hospital mortality/amputation (revascularization: odds ratio [OR] 4.6, 95% CI 3.3–6.2, p < 0.001; no revascularization: OR 3.1, 95% CI 2.8–3.3, p < 0.001) and mortality (revascularization: OR 5.5, 95% CI 3.4–8.7, p < 0.001; no revascularization: OR 5.1, 95% CI 4.6–5.6, p < 0.001) compared with the low-risk group. Conclusion: In patients with ESKD and PAD, the HFRS serves as a valuable predictor of mortality and amputation irrespective of revascularization. This information can support informed decision-making.