The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Association between initial vascular access and survival in hemodialysis according to age

  • Kim, Ha Yeon (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Bae, Eun Hui (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Ma, Seong Kwon (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Soo Wan (Department of Internal Medicine, Chonnam National University Medical School)
  • Received : 2017.01.18
  • Accepted : 2017.06.19
  • Published : 2019.07.01
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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.

Keywords

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP) (2015R1D1A1A01061037), by Basic Science Research Program through the NRF funded by the MSIP (2016R1A2B4007870), by the Pioneer Research Center Program through the NRF funded by the MSIP (2014M3C1A3053036), and by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Korea (HI14C2084), by the Bio & Medical Technology Development Program of the NRF funded by the MSIP (2017M3A9E8023001), and by a grant of the Chonnam National University Hospital Biomedical Research Institute (CRI16013-1).

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