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

Ren Fail. 2024 Dec;46(2):2387205. doi: 10.1080/0886022X.2024.2387205. Epub 2024 Aug 9.

Abstract

Background: To compare the impact of tunneled cuffed catheters (TCCs) and arteriovenous fistulas (AVFs) on outcomes in elderly hemodialysis (HD) patients.

Methods: 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.

Results: 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 vs. 33.3/100 patient-years, p = 0.124). Among the propensity score-matched cohorts, no significant differences in Kaplan-Meier curves were observed between the two groups (log-rank p = 0.242). The TCC group had higher rates of MACCEs, hospitalization, and infection than the AVF group (33.7/100 vs. 29.5/100 patient-years, 101.2/100 vs. 79.5/100 patient-years, and 30.1/100 vs. 14.1/100 patient-years, respectively). Multivariate analysis showed that high Charlson comorbidity index (CCI) score was a risk factor for death.

Conclusions: 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.

Keywords: Hemodialysis; arteriovenous fistula; mortality; propensity score matching; tunneled cuffed catheter.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arteriovenous Shunt, Surgical* / adverse effects
  • China / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / mortality
  • Kidney Failure, Chronic* / therapy
  • Male
  • Prognosis
  • Propensity Score*
  • Renal Dialysis*
  • Retrospective Studies
  • Risk Factors

Grants and funding

This work was supported by the Medical Science and Technology Research Foundation of Guangdong Province (grant No. A2023312), National Demonstration and Pilot Project for Inheriting and Developing Traditional Chinese Medicine (Zhongshan Health Commission, grant No. [2023]66), the Project of Guangdong Administration of Traditional Chinese Medicine (grant No. 20223020), Zhongshan Social Welfare Science and Technology Research Project (2021B3004), and Famous Traditional Chinese Medicine Studio of Yan-lin Li.