Type of vascular access and survival among very elderly hemodialysis patients

Area of Science:

• Nephrology
• Geriatrics
• Vascular Surgery

Background:

• Central venous catheters (CVC) for hemodialysis (HD) are linked to increased mortality versus arteriovenous access (AV).
• Limited research exists on vascular access type's impact on survival in very elderly patients (≥75 years) initiating HD.

Purpose of the Study:

• To investigate the influence of vascular access type on all-cause mortality in very elderly patients (≥75 years) initiating hemodialysis.
• To compare survival rates between CVC and AV access in incident HD patients aged 75 and older.

Main Methods:

• A cohort study of 5,466 incident hemodialysis patients, including 1,841 aged ≥75 years.
• Vascular access was categorized as CVC (tunneled and non-tunneled) or AV (fistula and grafts).
• All-cause mortality was the primary outcome, analyzed using survival statistics and multivariate analysis.

Main Results:

• In the overall cohort, AV access demonstrated a survival advantage over CVC (88% vs. 75% at 2 years; 63% vs. 48% at 5 years).
• Among patients ≥75, AV use was associated with significantly better survival than CVC use (80% vs. 68% at 2 years; 53% vs. 43% at 5 years).
• Multivariate analysis identified CVC use and arrhythmia as independent risk factors for death in patients ≥75; obesity was linked to improved survival.

Conclusions:

• Vascular access type significantly impacts survival in very elderly patients initiating hemodialysis.
• Central venous catheter use is associated with poorer survival outcomes compared to arteriovenous access in this population.
• Arteriovenous access should be prioritized for very elderly patients starting hemodialysis to improve survival.