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

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

Ru-Xin Liu  1 , Shuai Lin  1 , Li Liu  1 , Juan Xu  1 , Lin-Na Liu  1 , Jie Pang  1 , Hai-Wen An  1 , Wen-Qin Yang  1 , Jian-Lin Jian  1 , Jin Wang  1 , Zhi-Lan He  1 , Xiao-Lan Luo  1 , Hui Zou  1 , Yuan Zeng  1 , Qing-Xiu Huang  1 , Yan-Lin Li  1
Affiliations
Comparative Study

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

Ru-Xin Liu et al. Ren Fail. 2024 Dec.

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.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Study profile. HD: hemodialysis; TCC: tunneled cuffed catheter; AVF: arteriovenous fistulas.
Figure 2.
Figure 2.
Kaplan–Meier survival for the TCC and AVF patients. (A) Patients before matching; (B) patients after PSM. TCC: tunneled cuffed catheter; AVF: arteriovenous fistulas; PSM: propensity score matching.
Figure 3.
Figure 3.
Risk of the occurrence of a first MACCE after PSM. MACCE: main adverse cardiovascular and cerebrovascular events; TCC: tunneled cuffed catheter; AVF: arteriovenous fistulas; PSM: propensity score matching.
See this image and copyright information in PMC

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