Journal Article

Vascular access type and prognosis in elderly hemodialysis patients: a propensity-score-matched study

Liu, Li, Liu, Ru-xin, Yang, Wen-qin, Zou, Hui, Pang, Jie, Huang, Qing-xiu, Liu, Lin-na, He, Zhi-lan, An, Hai-wen, Lin, Shuai, Xu, Juan, Zeng, Yuan, Wang, Jin, Jian, Jian-lin, Li, Yan-lin, Luo, Xiao-lan

2024

Overview

To compare the impact of tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) on outcomes in elderly hemodialysis (HD) patients. A retrospective matched cohort study was performed. Propensity score matching (PSM) was applied to balance the baseline conditions, and we compared all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCEs), hospitalization, and infection rates between AVF and TCC patients ≥70 years old. Cox survival analysis was used to analyze the risk factors for death. There were 2119 patients from our center in the Chinese National Renal Data System (CNRDS) between 1 January 2010 and 10 October 2023. Among these patients, 77 TCC patients were matched with 77 AVF patients. There was no significant difference in all-cause mortality between the TCC and AVF groups (30.1/100 33.3/100 patient-years,  = 0.124). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank  = 0.242). The TCC group had higher rates of MACCEs, hospitalization, and infection than the AVF group (33.7/100 29.5/100 patient-years, 101.2/100 79.5/100 patient-years, and 30.1/100 14.1/100 patient-years, respectively). Multivariate analysis showed that high Charlson comorbidity index (CCI) score was a risk factor for death. There was no significant difference in all-cause mortality between elderly HD patients receiving TCCs and AVFs. Compared with those with a TCC, elderly HD patients with an AVF have a lower risk of MACCEs, hospitalization, and infection.

• Publisher: Taylor & Francis Ltd,Taylor & Francis,Taylor & Francis Group
• Subject: Aged / Aged, 80 and over / arteriovenous fistula / Arteriovenous Shunt, Surgical - adverse effects / Cardiovascular diseases / China - epidemiology / Comorbidity / Female / Hemodialysis / Hemodialysis and Peritoneal Dialysis / Hospitalization / Hospitalization - statistics & numerical data / Humans / Infections / Kaplan-Meier Estimate / Kidney Failure, Chronic - complications / Kidney Failure, Chronic - mortality / Kidney Failure, Chronic - therapy / Male / Medical prognosis / Mortality / Multivariate analysis / Patients / Prognosis / Propensity Score / propensity score matching / Renal Dialysis / Retrospective Studies / Risk Factors / Survival analysis / tunneled cuffed catheter