Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database
- Authors
- Kim, Hyangkyoung; Park, Hoon Suk; Ban, Tae Hyun; Yang, Seung Boo; Kwon, Young joo; Korean Society of Dialysis Access
- Issue Date
- Jul-2023
- Publisher
- Multimed, Inc.
- Keywords
- arteriovenous fistula; arteriovenous graft; elderly; outcomes; vascular access
- Citation
- Hemodialysis International, v.27, no.3, pp 249 - 258
- Pages
- 10
- Indexed
- SCIE
SCOPUS
- Journal Title
- Hemodialysis International
- Volume
- 27
- Number
- 3
- Start Page
- 249
- End Page
- 258
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/62884
- DOI
- 10.1111/hdi.13077
- ISSN
- 1492-7535
1542-4758
- Abstract
- Introduction
As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.
Methods
In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.
Results
Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all p values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (p < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; p < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; p < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; p < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; p < 0.001).
Conclusion
Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.
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Collections - 2. Clinical Science > Department of Nephrology and Hypertension > 1. Journal Articles
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