ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1355

Catheter Dependency After Vascular Access Placement Among Elderly Patients on Hemodialysis: An Intention-to-Treat Analysis

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Lyu, Beini, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Chan, Micah R., University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States
Background

Evidence is mixed regarding optimal choices of incident vascular access type for elderly patients on hemodialysis (HD). Arteriovenous fistula (AVF) may be desirable given its better long-term outcomes. However, many elderly patients have a lower probability of AVF maturation and limited life expectancy that may limit the potential long-term benefit of AVF. We aimed to use an intention-to-treat (ITT) analysis to assess catheter dependency after incident AVF/arteriovenous graft (AVG) placement among elderly patients on HD

Methods

Patients who were ≥67 years old at HD initiation, with no AVF/AVG placed before HD initiation, and had a first AVF/AVG placed within 1 year after HD initiation between May 2012 and May 2017 in the USRDS were included. Patients were followed from the first AVF/AVG placement using ITT analysis principles. Vascular access in use for HD was assessed using CrownWeb data. Catheter dependency was defined as using catheter only or using AVF/AVG combined with a catheter for HD.

Results

A total of 39,036 patients were included. Among them, 31,190 (79.9%) had AVF and 7846 (21.1%) had AVG placed. A substantially lower proportion of patients in the AVG group relied on catheter for HD early after VA placement (88.2% vs 91.9% in AVG and AVF, respectively, at 1m after placement; 23.3% vs 64.3% at 3m; 16.4% vs 28.9% at 6m, Fig1). In longer follow-up, proportion of catheter dependency was similar among patients remaining on HD in both groups, with slightly higher proportion in the AVG group observed at 1 year and beyond (14.8% vs 12.3% at 12m; 14.6% vs 9.6% at 24 m). Risk of mortality was high in both group (24.8% in AVF vs 28.7% in AVG by 12m; 42.4% in AVF vs 46.7% in AVG by 24m after VA placement).

Conclusion

AVG is associated with substantially less catheter dependency than AVF in the short-term and only slightly higher catheter dependency at one year and beyond. AVG placement may be beneficial in selected elderly patients to minimize catheter use.