Comparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients

Journal of Vascular Surgery
Claude J RenaudAnantharaman Vathsala

Abstract

The number of elderly (≥65 years) end-stage renal disease (ESRD) patients on hemodialysis is rapidly increasing. Vascular access outcomes remain contradictory and understudied across different elderly populations. We hypothesized age might influence primary autogenous fistula use and outcomes in a predominantly diabetic multiethnic Asian ESRD population. Demographic and clinical factors affecting fistula patency and maturation were retrospectively compared among patients with incident ESRD aged <65 and ≥65 years at a single center. Fistula patency was estimated by Kaplan-Meier curves with log-rank test comparison. We analyzed 280 primary fistulas (59% radiocephalic, 33% brachiocephalic, and 8% brachiobasilic) in this cohort consisting of 31.8% aged ≥65 years, 50% Chinese, 39% Malay, 42% women, and 70% diabetic. One- and 2-year primary and secondary patency in patients aged <65 vs ≥65 years were comparable: 41.3% vs 36.7% and 28.7% vs 24.4% (P = .547) and 57.7% vs 56.8% and 47.1% vs 47.2% (P = .990). On multivariate analysis, only non-Chinese, dialysis initiation with tunneled catheters, and surgical/endovascular interventions affected fistula survival hazard ratios (HR): 0.622 (95% confidence interval [CI], 0.43-1.00), 0.549 (9...Continue Reading

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Citations

Dec 3, 2014·Annals of Vascular Surgery·Kevin T ClaudeanosChristopher G Carsten
Oct 1, 2015·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Yit-Sheung YapYi-Chun Liu
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Mar 7, 2021·International Urology and Nephrology·Peiyun LiuChieh Suai Tan
Dec 12, 2017·Journal of Vascular Surgery·Jonathan MisskeyYork Hsiang

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