Related Experiment Video
Updated: Jun 17, 2025
A Murine Model of Hemodialysis Access-Related Hand Dysfunction
Published on: May 31, 2022
Vascular access type and prognosis in elderly hemodialysis patients: a propensity-score-matched study
Ru-Xin Liu1, Shuai Lin1, Li Liu1
1Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Zhongshan, China.
Insights
For elderly hemodialysis patients, arteriovenous fistulas (AVFs) show lower risks of major adverse cardiovascular and cerebrovascular events (MACCEs), hospitalization, and infection compared to tunneled cuffed catheters (TCCs). All-cause mortality did not significantly differ between AVF and TCC groups.
Area of Science:
- Nephrology
- Vascular Access
- Geriatric Medicine
Background:
- Elderly hemodialysis (HD) patients often have unique vascular access needs.
- Tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) are common vascular access methods.
- Comparing outcomes between TCCs and AVFs in elderly HD patients is crucial for optimizing care.
Purpose of the Study:
- To compare the impact of TCCs versus AVFs on key clinical outcomes in elderly HD patients.
- To evaluate differences in mortality, MACCEs, hospitalization, and infection rates.
- To identify risk factors for mortality in this population.
Main Methods:
- Retrospective matched cohort study using propensity score matching (PSM).
- Comparison of all-cause mortality, MACCEs, hospitalization, and infection rates.
- Cox survival analysis for risk factor identification in patients ≥70 years old.
Main Results:
- No significant difference in all-cause mortality between TCC and AVF groups (30.1/100 vs. 33.3/100 patient-years).
- AVF group showed significantly lower rates of MACCEs, hospitalization, and infection compared to the TCC group.
- High Charlson Comorbidity Index (CCI) score identified as a risk factor for death.
Conclusions:
- AVFs are associated with reduced risks of MACCEs, hospitalization, and infection in elderly HD patients compared to TCCs.
- No significant difference in all-cause mortality was observed between AVF and TCC vascular access.
- Vascular access choice impacts morbidity but not overall mortality in elderly HD patients.
Background:
To compare the impact of tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) on outcomes in elderly hemodialysis (HD) patients.
Methods:
A retrospective matched cohort study was performed. Propensity score matching (PSM) was applied to balance the baseline conditions, and we compared all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCEs), hospitalization, and infection rates between AVF and TCC patients ≥70 years old. Cox survival analysis was used to analyze the risk factors for death.
Results:
There were 2119 patients from our center in the Chinese National Renal Data System (CNRDS) between 1 January 2010 and 10 October 2023. Among these patients, 77 TCC patients were matched with 77 AVF patients. There was no significant difference in all-cause mortality between the TCC and AVF groups (30.1/100 vs. 33.3/100 patient-years, p = 0.124). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank p = 0.242). The TCC group had higher rates of MACCEs, hospitalization, and infection than the AVF group (33.7/100 vs. 29.5/100 patient-years, 101.2/100 vs. 79.5/100 patient-years, and 30.1/100 vs. 14.1/100 patient-years, respectively). Multivariate analysis showed that high Charlson comorbidity index (CCI) score was a risk factor for death.
Conclusions:
There was no significant difference in all-cause mortality between elderly HD patients receiving TCCs and AVFs. Compared with those with a TCC, elderly HD patients with an AVF have a lower risk of MACCEs, hospitalization, and infection.
