Related Experiment Video
Updated: Jan 3, 2026
A Murine Model of Hemodialysis Access-Related Hand Dysfunction
Published on: May 31, 2022
Effects of patient age on patency of chronic hemodialysis vascular access
Seonjeong Jeong1, Hyunwook Kwon1, Jai Won Chang2
1Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Insights
Older hemodialysis patients benefit from arteriovenous fistula (AVF) placement, showing longer primary and secondary patency. A fistula-first approach is recommended for appropriate elderly patients to improve vascular access longevity.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Assessing long-term vascular access (VA) patency in hemodialysis (HD) patients.
- Identifying independent risk factors for VA patency in Asian HD patients, stratified by age.
- Investigating VA patency factors in older HD patients based on access type.
Purpose of the Study:
- To evaluate the long-term patency of vascular access (VA) after initial placement in hemodialysis (HD) patients.
- To identify independent risk factors for VA patency in Asian HD patients, considering age stratification.
- To examine factors influencing VA patency in elderly HD patients based on the type of VA used.
Main Methods:
- Retrospective observational study of 651 chronic HD patients with first upper-extremity VA placement (Jan 2011-Dec 2013).
- Patients stratified into nonelderly (<65 years) and elderly (≥65 years) groups.
- Kaplan-Meier survival analysis and multivariate analysis to determine primary and secondary VA patency outcomes.
Main Results:
- Autologous arteriovenous fistula (AVF) was more frequent in nonelderly patients.
- Primary patency was longer in nonelderly patients; secondary patency was similar between age groups.
- Increased age correlated with shorter primary patency; AVF placement was associated with longer primary and secondary patency. Diabetes mellitus was linked to shorter secondary patency.
Conclusions:
- Increased age negatively impacts primary VA patency but not secondary patency.
- Arteriovenous fistula (AVF) placement is associated with superior primary and secondary patency compared to other VA types.
- A fistula-first strategy is recommended for suitable elderly hemodialysis patients to enhance vascular access outcomes.
Background:
In this single-center, retrospective observational study, we assessed the long-term patency of vascular access (VA) after first VA placement to uncover independent risk factors associated with VA patency in Asian hemodialysis (HD) patients stratified by age. We also investigated factors associated with VA patency among older HD patients according to the type of VA in the overall study population.
Methods:
The study period was from January 2011 to December 2013. A total of 651 chronic HD patients with confirmed first upper-extremity VA placement were enrolled, and their records were analyzed retrospectively. A total of 445 patients (68.4%) made up the nonelderly group (< 65 years), and 206 patients (31.6%) were in the elderly group (≥ 65 years). Study outcomes were defined as primary or secondary VA patency.
Results:
Autologous arteriovenous fistula (AVF) was more common in the nonelderly group (P < 0.01). Kaplan-Meier curve survival analysis indicated that primary patency was longer in the nonelderly group (P < 0.01); secondary patency, however, was similar between groups (P = 0.37). The multivariate analysis of factors associated with primary VA patency revealed that increased age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01-1.03; P < 0.01) was associated with shorter primary patency, and AVF (HR, 0.38; 95% CI, 0.28-0.51; P < 0.01) was associated with longer primary patency. AVF (HR, 0.57; 95% CI, 0.37-0.87; P = 0.010) and diabetes mellitus (HR, 1.56; 95% CI, 1.07-2.29; P = 0.02) were independently associated with longer and shorter secondary patency periods, respectively; however, increased age was not a risk factor for decreased secondary patency.
Conclusions:
Increased age was associated with shorter primary patency but not secondary patency, whereas AVF placement was associated with longer primary and secondary patency. Considering the similar rates of secondary patency between groups and the superior patency of AVF compared to arteriovenous graft, a fistula-first strategy should be applied to appropriate older patients.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:25Hemodialysis III: Nursing Management
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:24Hemodialysis II: Procedure and Complications
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
01:27Pharmacodynamics in Geriatric Patients: Effects of Age