title: Comparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients.
abstract: BACKGROUND
  The number of elderly (≥65 years) end-stage renal disease (ESRD) patients on hemodialysis is rapidly increasing. Vascular access outcomes remain contradictory and understudied across different elderly populations. We hypothesized age might influence primary autogenous fistula use and outcomes in a predominantly diabetic multiethnic Asian ESRD population.
  
  
  METHODS
  Demographic and clinical factors affecting fistula patency and maturation were retrospectively compared among patients with incident ESRD aged <65 and ≥65 years at a single center. Fistula patency was estimated by Kaplan-Meier curves with log-rank test comparison.
  
  
  RESULTS
  We analyzed 280 primary fistulas (59% radiocephalic, 33% brachiocephalic, and 8% brachiobasilic) in this cohort consisting of 31.8% aged ≥65 years, 50% Chinese, 39% Malay, 42% women, and 70% diabetic. One- and 2-year primary and secondary patency in patients aged <65 vs ≥65 years were comparable: 41.3% vs 36.7% and 28.7% vs 24.4% (P = .547) and 57.7% vs 56.8% and 47.1% vs 47.2% (P = .990). On multivariate analysis, only non-Chinese, dialysis initiation with tunneled catheters, and surgical/endovascular interventions affected fistula survival hazard ratios (HR): 0.622 (95% confidence interval [CI], 0.43-1.00), 0.549 (95% CI, 0.297-0.841), and 2.503 (95% CI, 1.695-3.697), respectively. Nonmaturation and intervention rates were also similar at 56.7% vs 61.8% and 34% vs 32.2% at 3 and 6 months and 0.31 vs 0.36 per access year, respectively (P > .05). Females and tunneled catheters were the only risk factors for nonmaturation (HR, 1.568; 95% CI, 1.148-1.608, and HR, 1.623; 95% CI, 1.400-1.881, respectively).
  
  
  CONCLUSIONS
  A primary fistula strategy in incident elderly ESRD is feasible and does not result in inferior outcomes. Age should therefore not be a determinant for primary fistula creation.
authors.affiliation: Division of Nephrology, Department of Medicine, National University Health System, Singapore. renaudcj@hotmail.com
authors.forename: Claude J
authors.initials: CJ
authors.lastname: Renaud
authors.forename: Jackie Ho
authors.initials: JH
authors.lastname: Pei
authors.forename: Evan J C
authors.initials: EJ
authors.lastname: Lee
authors.forename: Peter A
authors.initials: PA
authors.lastname: Robless
authors.forename: Anantharaman
authors.initials: A
authors.lastname: Vathsala
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical; D044466:Asian People; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency