S-Space College of Medicine/School of Medicine (의과대학/대학원) Internal Medicine (내과학전공) Journal Papers (저널논문_내과학전공)
Autologous arteriovenous fistula is associated with superior outcomes in elderly hemodialysis patients
- Bae, Eunjin; Lee, Hajeong; Kim, Dong Ki; Oh, Kook-Hwan; Kim, Yon Su; Ahn, Curie; Han, Jin Suk; Min, Sang-Il; Min, Seung-Kee; Kim, Hyo-Cheol; Joo, Kwon Wook
- Issue Date
- BioMed Central
- BMC Nephrology, 19(1):306
- Elderly; Hemodialysis; Vascular access type; Vascular access abandonment; All-cause mortality
The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients.
We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG). The primary outcomes were VA abandonment and all-cause mortality. The secondary outcome was maturation failure (MF).
Of 529 patients, 61.2% were men. The mean age was 73.6 ± 6.0 years. The VA types were as follows: 49.9% radiocephalic AVF, 31.8% brachiocephalic AVF, and 18.3% AVG. Patients with an AVG tended to be older, female, and have a lower body mass index. More than half of patients (n = 302, 57.1%) started dialysis with central catheters, but the proportion of predialysis central catheter placement was not different among the VA types. Radiocephalic AVF was significantly superior to AVG in terms of VA abandonment (P = 0.005) and all-cause mortality (P < 0.001) in spite of a higher probability of MF. Brachiocephalic AVF was associated with a shorter time to the first needling and fewer interventions before maturation than radiocephalic AVF.
Autologous AVF was suggested as the preferred VA choice in terms of long-term outcomes in elderly patients.