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

Authors
  • Bae, Eunjin1
  • Lee, Hajeong2, 3
  • Kim, Dong Ki2, 3
  • Oh, Kook-Hwan2
  • Kim, Yon Su2, 3
  • Ahn, Curie2, 3
  • Han, Jin Suk2, 3
  • Min, Sang-Il4
  • Min, Seung-Kee4
  • Kim, Hyo-Cheol5
  • Joo, Kwon Wook2, 3, 6
  • 1 Gyeongsang National University Changwon Hospital, Department of Internal Medicine, Changwon, South Korea , Changwon (South Korea)
  • 2 Seoul National University Hospital, Department of Internal Medicine, Seoul, South Korea , Seoul (South Korea)
  • 3 Kidney Reasearch Institute, Seoul National University College of Medicine, Seoul, South Korea , Seoul (South Korea)
  • 4 Seoul National University College of Medicine, Department of Surgery, Seoul, South Korea , Seoul (South Korea)
  • 5 Seoul National University College of Medicine, Department of Radiology, Seoul, South Korea , Seoul (South Korea)
  • 6 Seoul National University College of Medicine, Department of Internal Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea , Seoul (South Korea)
Type
Published Article
Journal
BMC Nephrology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Nov 06, 2018
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12882-018-1109-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe 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.MethodsWe 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).ResultsOf 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.ConclusionsAutologous AVF was suggested as the preferred VA choice in terms of long-term outcomes in elderly patients.

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