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Kidney Week

Abstract: SA-PO1108

Hemodialysis Access in the Elderly and Survival

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

Author

  • Navarrete, Jose E., Emory University, Atlanta, Georgia, United States
Background

To determine if achiveing the goal of having an AV fistula impacts survival in elderly dialysis patients.

Methods

Incident hemodialysis patients age 70 or older admitted to Emory Dialysis program form 1/2011 to 12/2015 were followed until death, transplant, or censoring up to 12/31/18. Demographic, laboratory and hemodialysis data were obtained. Patients were categorized as C if they only dialyzed with a catheter, G if they were able to dialyze with a graft and F if they used a fistula for dialysis.

Results

189 patients were included. 30%, 29% and 41% of patiens used a C, G or F respectively. Demographics and comorbidities were similar among groups but diabetes was more common (65%) in G users than C or F (40 and 56%). Use of C was associated with lower survival compare to G or F (Figure 1). Patients using C were more likely to be hospitalized than those using G (RR 1.8, CI 1.1-3.1, p=0.005) or F (RR 2.6, CI 1.5-4.5, p<0.01). Hospitalization risk was higher in patients with G compared F (RR 1.4, CI 0.9-2.4, p=0.3) but the difference was not statistically significant. IV antibiotics use was more common in patients with C. 10.5%, 6.5% and 3.7% of patients used IV antibiotics in the catheter, graft and fistula groups respectively (p<0.05).

Conclusion

Elderly patients dialyzed with a catheter had lower survival than patients dialyzed with a graft or a fistula. There was no survival difference between patients using grafts or fistulas for dialysis. Patients using a dialysis catheter were significantly more likely to receive IV antibiotics and were hospitalized more often than patients using a fistula or a graft. There was no difference in hospitalization rate between G and F. These results underscore the importance of avoiding dialysis catheters as long term dialysis AV access and suggest that AV graft could be a reasonable dialysis access option in elderly patients.