Korean J Intern Med.  2019 Jul;34(4):867-876. 10.3904/kjim.2017.025.

Association between initial vascular access and survival in hemodialysis according to age

• Kim HY
• Bae EH
• Ma SK
• Kim SW

• KMID: 2457317
• DOI: http://doi.org/10.3904/kjim.2017.025

Abstract

BACKGROUND/AIMS
This study aims to demonstrate whether the association between initial vascular access and mortality among hemodialysis patients varies by age.
METHODS
We conducted a retrospective study that included 2,552 patients who started hemodialysis. Vascular access was divided into three categories: percutaneous catheter, tunneled cuffed catheter, and arteriovenous (AV) access.
RESULTS
Survival rates for patients who received a central venous catheter, such as percutaneous or tunneled cuffed catheter, aged 65 to 74 years and those ≥ 75 years were reduced, but not for those aged < 65 years (log-rank test; p < 0.001, p = 0.007, and p = 0.278). After fully adjusting for potential confounding factors in the patients aged < 65 years, percutaneous and tunneled cuffed catheter were not associated with 5-year mortality. On the other hand, for patients aged 65 to 74 or ≥ 75 years, percutaneous catheter and tunneled cuffed catheter were associated with higher 5-year mortality rates. As age increased, the conversion rate from central venous catheter, including percutaneous catheter and tunneled cuffed catheter, to AV access decreased (94.1%, 90.5%, and 80.3% for patients aged < 65, 65 to 74, and ≥ 75 years, respectively; p < 0.001).
CONCLUSIONS
In patients aged ≥ 65 years, initial vascular access was associated with long-term mortality. We suggest that a "fistula first" strategy is superior for elderly patients and demonstrates that it is desirable to change to AV access, and not maintain an initial central vascular catheter.

Keyword

Vascular access; Age; Hemodialysis

MeSH Terms

Aged
Catheters
Central Venous Catheters
Hand
Humans
Mortality
Renal Dialysis*
Retrospective Studies
Survival Rate
Vascular Access Devices