Catheter Dependence After Arteriovenous Fistula or Graft Placement Among Elderly Patients on Hemodialysis.
Creation of an arteriovenous fistula (AVF), compared to an AV graft (AVG), is associated with longer initial catheter dependence after starting hemodialysis but longer access survival and lower long-term catheter dependence. The extent of these potential long-term benefits in elderly patients is unknown. We assessed catheter dependence after AVF or AVG placement among elderly patients who initiated HD without a permanent access in place.Retrospective cohort study.Patients ≥67 years of age identified in the United States Renal Data System (USRDS) who had a first AVF (n=14,532) or AVG (n=3391) placed within 1 year after HD initiation between May 2012 and May 2017.AVF versus AVG placement in first year of hemodialysis.Catheter dependence after AVF or AVG placement assessed using CROWNWeb data. ANALYTICAL APPROACH: – Generalized estimating equations and negative binomial regression for catheter use over time and Cox proportional hazards models for mortality.Creation of an AVF versus AVG was associated with greater catheter dependence at one month (95.6% vs. 92.5%) and at three months (82.8% vs. 41.2%), but lower catheter dependence at 12 months (14.2% vs. 15.8%) and at 36 months (8.2% vs. 15.0%). Creation of an AVF, however, remained significantly associated with greater cumulative catheter-dependent days (80.1 vs 54.6 days per person-year) and a lower proportion of catheter-free survival time (78.1% vs 85.1%) after three years of follow-up.Potential for unmeasured confounding and analyses limited to elderly patients.Creation of an AVF was associated with significantly greater cumulative catheter dependence than placement of an AVG in an elderly population initiating HD without a permanent access. As the long-term benefits in terms of catheter dependency of an AVF are not realized in many elderly patients, specific patient characteristics should be considered when making decisions regarding vascular access.
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Authors: Beini Lyu, Micah R Chan, Alexander S Yevzlin, Brad C Astor