title: Type of vascular access and survival among very elderly hemodialysis patients.
abstract: The use of central venous catheters (CVC) for hemodialysis (HD) is associated with higher mortality compared to arteriovenous access (AV). However, studies analyzing the influence of the type of vascular access on the survival of very elderly patients (≥75 years) initiating HD are few and involve only a limited number of patients. We studied a cohort of 5,466 incident patients who started HD; of these, 1,841 were aged ≥75. Types of vascular access for HD were classified as either CVC, which included both tunneled and non-tunneled catheters, or AV, which included AV fistula and grafts. The outcome of the study was all-cause mortality during the follow-up period. In the whole cohort, AV use was associated with a survival advantage over CVC use (88 and 63% at 2 and 5 years, respectively, in patients with an AV as compared to 75 and 48% in patients with a CVC) (p < 0.0001). Among patients ≥75, CVC use was associated with a higher number of deaths compared to AV use. Patients ≥75 with an AV showed a greater survival as compared to patients ≥75 with a CVC (80 and 53% at 2 and 5 years, respectively, vs. 68 and 43%; p < 0.0001). Multivariate analysis revealed that CVC use and the presence of arrhythmia were independent risk factors of death in patients ≥75, whereas obesity was associated with greater survival. In conclusion, the type of vascular access has a significant influence on the survival of very elderly patients (≥75) initiating HD. CVC use was associated with poorer survival compared to AV access.
authors.affiliation: Nephrology Division, Instituto de Investigación Hospital 12 de Octubre, Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Merello
authors.forename: Ines
authors.initials: I
authors.lastname: Palomares
authors.forename: Inga
authors.initials: I
authors.lastname: Bayh
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.forename: Pedro
authors.initials: P
authors.lastname: Aljama
authors.forename: José
authors.initials: J
authors.lastname: Luño
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000145:classification* / Q000401:mortality* / Q000706:statistics & numerical data; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000517:prevention & control*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult