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Abstract: PO1374

Vascular Access Type and Survival Outcomes in Elderly Hemodialysis Patients

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Roldão, Marisa, Centro Hospitalar do Medio Tejo EPE Unidade de Torres Novas, Torres Novas, Santarém, Portugal
  • Figueiredo, Cátia Raquel, Centro Hospitalar do Medio Tejo EPE Unidade de Torres Novas, Torres Novas, Santarém, Portugal
  • Escoli, Rachele Da silva, Centro Hospitalar do Medio Tejo EPE Unidade de Torres Novas, Torres Novas, Santarém, Portugal
  • Gonçalves, Hernâni Martins, Centro Hospitalar do Medio Tejo EPE Unidade de Torres Novas, Torres Novas, Santarém, Portugal
Background

The ideal vascular access for elderly hemodialysis (HD) patients remains widely debated. Limited life expectancy and lower arteriovenous access (AVA) maturation rates increase the likelihood of starting HD with a central venous catheter (CVC). The aim of the study was to evaluate the influence of vascular access type in survival outcomes for elderly HD patients.

Methods

Single-center retrospective cohort study of incident HD patients aged > 80 years from January 2010 to May 2021. Patients who recovered renal function or switched to another renal replacement therapy were excluded. Patients were categorized according to their vascular access at the beginning of dialysis: CVC or AVA. Baseline clinical and demographic data were compared among groups. Survival outcomes by the end of follow-up (31st May 2021) were analyzed using Kaplan-Meier survival curves and Cox's proportional hazards model. Statistical analysis was performed using SPSS (Version 23 for Mac OSX).

Results

The study included 99 patients: 48 (48.5%) were male, 44 (44.4%) diabetic, 60 (60.6%) had isquemic heart disease and 15 (15.2%) peripheral artery disease. Mean Charlson Comorbidity Index was 8.41±1.65 and mean age 85.14±3.98 years. Eleven patients (11.1%) were over 90 years old. Eighty patients (81%) started HD urgently as inpatients. The vascular access at dialysis start was a CVC in 75.8% (n=75) and an AVA in 24.2% (n=24). No statistical differences were found in age, gender, or comorbidities among groups. During a mean follow-up of 2.3 years, there were 64 deaths, 27 due to infections (12 access-related infections). All-cause mortality (HR [95% CI]: 1.92 [1.05-3.49], p=0.033) and infection-related mortality (HR: 5.87 [1.38-24.94], p=0.017) were significantly higher among patients who initiate HD with a CVC as compared to an AVA.

Conclusion

The ideal vascular access in elderly patients remains controversial. Our results suggest that patients who start HD with a CVC presented higher all-cause and infection-related mortality when compared with patients who start with an AVA. Our study supports the initiative “fistula first” however more studies are needed to confirm the observations.