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Kidney Week

Abstract: SA-PO1104

The Impact of Comorbidity Index on the Association Between Vascular Access Type and Clinical Outcomes Among Elderly Patients Undergoing Hemodialysis

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

  • Jhee, Jong Hyun, Inha University College of Medicine, Incheon, Korea (the Republic of)
  • Lee, Seoung woo, Inha University Hospital, Incheon, Korea (the Republic of)
Background

The optimal type of vascular access for the elderly undergoing hemodialysis is controversial. We aimed to evaluate the impact of comorbidity burden on the association between vascular access type and mortality risk among elderly patients maintaining hemodialysis.

Methods

A total of 23,100 patients with ≥65 years undergoing hemodialysis were recruited from the Korean end-stage renal disease registry data (2001-2018). Study subjects were stratified into tertile according to simplified Charlson comorbidity index (CCI) and compared the survival and hospitalization rate among the type of vascular access.

Results

Among all tertiles of sCCI, CVC use showed highest risk of mortality than AVF use. In the lowest to middle tertile, no difference was observed in survival rates between the use of AVF and AVG. However, in the highest tertile, AVG use showed higher risk of mortality than AVF use. When subjects were classified according to a combination of sCCI tertile and access type (AVF vs. AVG), patients with the highest CCI with AVG showed 1.75-folded increased risk of mortality than those with the lowest sCCI with AVF. Hospitalization rates due to access malfunction were highest in patients with CVC in all sCCI tertiles. In the highest tertile, patients with AVG showed increased rates of hospitalization compared to those with AVF due to access malfunction. However, hospitalization rates due to access infection were highest in patients with AVG in all tertiles.

Conclusion

The use of AVF may be of benefit and switching to AVF should be considered in elderly hemodialysis patients with a high burden of comorbidity.

The adjusted risk for all-cause mortality according to combination group of sCCI tertile and the type of vascular access (AVF vs. AVG)