Association between initial vascular access and survival in hemodialysis according to age
The Korean Journal of Internal Medicine
;
: 867-876, 2019.
Article
in English
| WPRIM
| ID: wpr-919030
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Type of study:
Observational study
Language:
English
Journal:
The Korean Journal of Internal Medicine
Year:
2019
Type:
Article
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