Association between initial type of hemodialysis access used in the elderly and mortality. Hemodial Int 2012 Apr;16(2):233-41
Date
04/11/2012Pubmed ID
22487417DOI
10.1111/j.1542-4758.2011.00661.xScopus ID
2-s2.0-84859591251 (requires institutional sign-in at Scopus site) 46 CitationsAbstract
We hypothesized that certain subpopulations (elderly and those with greater comorbidity) may not have significant benefit from "fistula first" initiative. A cohort of incident hemodialysis patients from 2005 to 2007, who were ≥70 years old, was derived from the United States Renal Data System. Primary variable of interest was type of vascular access used at first outpatient hemodialysis (i.e., fistula, graft, or central catheter), with primary outcome of all-cause mortality (time to death measured from the first outpatient hemodialysis). A cohort of 82,202 patients was stratified by age (70 to ≤80, 81 to ≤90, and >90). Each group demonstrated a survival benefit with the use of an arterio-venous fistula compared with catheter (hazard ratio [HR] 0.56 [P < 0.001], HR 0.55 [P < 0.001], and HR 0.69 [P = 0.007], respectively). Comparing graft to with a catheter, both groups, 70 to ≤80 and 81 to ≤90, had significant benefit compared with catheter (HR 0.73, P < 0.001 and HR 0.74, P < 0.001, respectively). However, significance was lost in those ≥90 (HR 0.83, P = 0.354). When substratified by comorbidity, those 81 to ≤90 years old with a history of malignancy or peripheral vascular disease also did not reach significant benefit compared with a catheter (HR 0.88, P = 0.423 and HR 0.85, P = 0.221, respectively). While specific subgroups in the hemodialysis population exist where use of fistulas and grafts at time of dialysis initiation is not of proven statistical benefit to survival, elderly hemodialysis patients with comorbidities still appear to benefit from the use of fistulas and grafts.
Author List
DeSilva RN, Sandhu GS, Garg J, Goldfarb-Rumyantzev ASMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Cohort Studies
Comorbidity
Female
Humans
Kidney Failure, Chronic
Male
Renal Dialysis
Survival Analysis
United States