Abstract: SA-PO0441
Fistula First in the Elderly? Vascular Access and Outcomes in Patients Older Than 75 Years Starting Hemodialysis
Session Information
- Dialysis: Vascular Access
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Silva, Eliana, Corporate Medical Office - Diaverum M42, Malmo, Sweden
- Santos Araujo, Carla Alexandra R., Corporate Medical Office - Diaverum M42, Malmo, Sweden
- Lucas, Carlos, Corporate Medical Office - Diaverum M42, Malmo, Sweden
- Macario, Fernando Jose Gordinho Rocha M, Corporate Medical Office - Diaverum M42, Malmo, Sweden
Background
Available evidence about the most suitable type of vascular access (VA) for elderly patients with end-stage renal disease (ESRD), especially those over the age of 75, is still conflicting, making decisions around VA construction in this population quite challenging. This study aims to evaluate the association between different types of VA and survival in HD patients aged 75 years and older.
Methods
We conducted a multicenter, prospective, observational study across 20 countries, within a large dialysis provider. All patients ≥75 years old who initiated HD during 2023 were included and followed until the end of 2024. Patients were stratified by their VA at baseline and after 3 months in the following groups: A) central venous catheter (CVC) throughout the period; B) arteriovenous fistula (AVF) throughout the period; C) CVC changing to AVF and D) AVF changing to CVC. Baseline demographic, clinical, and laboratory data were recorded. Survival analysis was performed using Kaplan-Meier analysis and Cox proportional-hazards modelling, with a focus on VA type.
Results
The study included 2713 HD patients: 1631 in group A, 971 in group B, 88 in group C and 23 in group D. The cohort who started treatment with CVC was older (mean age 80.9±4.36 vs. [B] 80.2±3.91 vs. [C] 80.4±4.31 vs. [D] 79.4±3.79, p<0.01), with an higher proportion of females (42.7% vs. [B] 31.6% vs. [C] 37.5% vs. [D] 43.5%, p<0.01) and higher proportion of diabetes (47.8% vs. [B] 43.6% vs. [C] 45.5% vs. [D] 52.2%, p<0.01). In adjusted models, and using group A as reference, patients maintaining an AVF exhibited significantly better survival (HR 0.65; CI, 0.53–0.79). Compared to the patients that remained with a CVC, changing VA during the 3-month period was not associated with a statistically significant survival benefit.
Conclusion
Among hemodialysis patients aged 75 and older, the use of an AVF from the start of treatment was independently associated with significantly improved survival compared to continued use of a CVC. These findings emphasize the critical role of early VA planning and suggest that, despite advanced age, prioritizing AVF use may offer substantial survival benefits in the elderly ESRD population.