Vascular access type and hemodialysis patient outcomes

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This study aimed to examine the impact of VA type on cardiovascular and all-cause mortality as well as the predictors for outcome in elderly Chinese patients” You et al (2019).

Abstract:

OBJECTIVES: Current studies suggest arteriovenous fistula (AVF) and arteriovenous graft as superior vascular access (VA) types for elderly hemodialysis (HD) patients due to better outcomes. This study aimed to examine the impact of VA type on cardiovascular and all-cause mortality as well as the predictors for outcome in elderly Chinese patients.

METHODS: Patients who initiated HD aged ≥70 years and received a primary VA creation at the West China Hospital were enrolled in this retrospective study. Clinical characteristics, maturation, utilization, conversion of VA, and outcomes were collected. The observational period for each patient was from the point of the first permanent VA creation to the last time of follow-up. Kaplan-Meier and multivariate regression analysis were employed.

RESULTS: A total of 358 elderly Chinese HD patients with a median age of 74 (72-78) years were analyzed. During the study period of 25.8 (12-43) months, 54 (15.1%) and 113 patients (15.1%) died of cardiovascular events and all-cause, respectively. With regard to VA type, the modality of AVF, tunneled cuffed central venous catheter (tcCVC), or AVF and tcCVC was not associated with mortality. Furthermore, diastolic blood pressure (DBP) and congestive heart failure (CHF) were the independent predictors for cardiovascular mortality.

CONCLUSIONS: The modality of VA types showed an insignificant effect on mortality in elderly Chinese population, while preoperative DBP and the presence of CHF might be used for the risk assessment of cardiovascular death. Disparities among nations in the areas of VA and HD necessitate additional studies.

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Reference:

Yu, Y., Xiong, Y., Zhang, C., Fu, M., Li, Y. and Fu, P. (2019) Vascular Access Type Was Not Associated with Mortality and the Predictors for Cardiovascular Death in Elderly Chinese Patients on Hemodialysis. Blood Purification. October 2nd. doi: 10.1159/000502941. .

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