Dialysis Access as an Area of Improvement in Elderly Incident Hemodialysis Patients: Results from a Cohort Study from the International Monitoring Dialysis Outcomes Initiative

American Journal of Nephrology
J G RaimannMonitoring Dialysis Outcomes (MONDO) Initiative

Abstract

Commencing hemodialysis (HD) using a catheter is associated with a higher risk of adverse outcomes, and early conversion from central-venous catheter (CVC) to arteriovenous fistula/graft (non-CVC) improves outcomes. We investigated CVC prevalence and conversion, and their effects on outcomes during the first year of HD in a multinational cohort of elderly patients. Patients ≥70 years from the MONDO Initiative who commenced HD between 2000 and 2010 in Asia-Pacific, Europe, North-, and South-America and survived at least 6 months were included in this investigation. We stratified by age (70-79 years [younger] vs. ≥80 years [older]) and compared access types (at first and last available date) and their changes. We studied the association between access at initiation and conversion, respectively, and all-cause mortality using Kaplan-Meier curve and Cox regression, and predicted the absence of conversion from catheter to non-CVC using adjusted logistic regression. In 14,966 elderly, incident HD patients, survival was significantly worse when using a CVC at all times. In Europe, the conversion frequency from CVC to non-CVC was higher in the younger fraction. Conversion from non-CVC to CVC was associated with worsened outcomes only in...Continue Reading

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Citations

May 17, 2017·American Journal of Nephrology·Miten J Dhruve, Christopher T Chan
Jul 16, 2019·The International Journal of Artificial Organs·Ursula HadimeriBernd Stegmayr
May 23, 2020·The International Journal of Artificial Organs·Bernd StegmayrBeat Walpoth
Oct 20, 2018·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Carlo LomonteFrank van der Sande
Jul 1, 2020·Annals of Vascular Surgery·Quinten DickenJeffrey J Siracuse

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