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Autologous arteriovenous fistula is associated with superior outcomes in elderly hemodialysis patients

Cited 2 time in Web of Science Cited 4 time in Scopus
Authors
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
2018-11-06
Publisher
BioMed Central
Citation
BMC Nephrology, 19(1):306
Keywords
ElderlyHemodialysisVascular access typeVascular access abandonmentAll-cause mortality
Abstract
Background
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.

Methods
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).

Results
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.

Conclusions
Autologous AVF was suggested as the preferred VA choice in terms of long-term outcomes in elderly patients.
ISSN
1471-2369
Language
English
URI
http://hdl.handle.net/10371/146884
DOI
https://doi.org/10.1186/s12882-018-1109-9
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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