Abstract: SA-PO1109
Age and Arteriovenous Fistula Placement, Maturation, and Patency Loss in Elderly: A Competing Risk Analysis
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Qian, Joyce Z., Johns Hopkins University, Baltimore, Maryland, United States
- Ng, Derek, Johns Hopkins University, Baltimore, Maryland, United States
- McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
Background
Choosing the optimal vascular access for older hemodialysis (HD) patients is of primary importance. Our study aims to determine the association of age with arteriovenous fistula (AVF) placement, maturation, primary patency loss, and abandonment in the U.S. older HD patients.
Methods
We identified three national retrospective cohorts of incident HD patients aged 67 years and older who initiated dialysis (43,851), had an AVF placed (14,892), or had the placed AVF matured (7,528) from United States Renal Data System (USRDS). AVF maturation, primary patency loss, and abandonment were ascertained monthly. Cut-off value for age categorization was identified by restricted cubic splines (RCS). Cause-specific and subdistribution proportional hazards models were used with kidney transplantation, peritoneal dialysis, and death treated as competing events. We compared inverse probability weighted (IPW) cumulative incidence functions (CIFs) by Gray’s test.
Results
Of 43,851 patients who initiated HD, 39.4% had an AVF placed. Among 14,892 patients with a placed AVF, 68.9% achieved maturation. In 7,528 matured AVFs, 75.2% had primary patency loss and 25.2% abandoned. Patients ≥77 years old had significantly lower probability for AVF placement (adjusted cHR 0.96, 95% CI 0.92-0.99; adjusted sHR 0.92, 95% CI 0.89-0.95; Gray’s test p<.0001) and maturation (adjusted cHR 0.95, 95% CI 0.91-0.99; adjusted sHR 0.93, 95% CI 0.90-0.97; p<.0001) as compared to those 67-<77. However, age is not associated with AVF primary patency loss (adjusted cHR 1.05, 95% CI 1.00-1.11; adjusted sHR 1.04, 95% CI 0.99-1.09; p=0.091) or abandonment (adjusted cHR 1.05, 95% CI 0.95-1.15; adjusted sHR 1.03, 95% CI 0.94-1.13; p=0.613).
Conclusion
In conclusion, the chance of AVF maturation is the most important consideration for vascular access planning. AVF might not be the best vascular access for older HD patients approaching eighty years old.