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. 2024;55(6):647-656.
doi: 10.1159/000541356. Epub 2024 Sep 7.

Association between Timing of Vascular Access Creation and Mortality in Patients Initiating Hemodialysis: A Nationwide Cohort Study in Japan

Minoru Murakami  1 , Naohiko Fujii  2   3 , Eiichiro Kanda  2   4 , Kan Kikuchi  2   5 , Atsushi Wada  2   6 , Takayuki Hamano  2   7   8 , Ikuto Masakane  2   9
Affiliations

Association between Timing of Vascular Access Creation and Mortality in Patients Initiating Hemodialysis: A Nationwide Cohort Study in Japan

Minoru Murakami et al. Am J Nephrol. 2024.

Abstract

Introduction: The optimal time for vascular access (VA) creation remains controversial.

Methods: We conducted a cohort study using data from the Japanese Society for Dialysis Therapy Renal Data Registry. Adult patients who started receiving hemodialysis in 2007 and had a permanent VA created were included. The exposure of interest was the timing of VA creation, categorized into three groups: early VA creation (defined as creation at least 4 months before hemodialysis initiation), just prior VA creation (creation between 1 and 3 months before hemodialysis initiation), and late VA creation (creation within 1 month of or after hemodialysis initiation). Cox regression analyses were used to compare 1-year all-cause mortality, with late VA creation as the reference group. Owing to the violations of the proportional hazards assumptions, the follow-up period was divided into "early" (1-4 months follow-up) and "late" (5-12 months follow-up) periods.

Results: Overall, 1,280 (15.4%) of 8,322 patients died. Both early creation and just prior creation were associated with lower all-cause mortality in the early period compared with late creation. In the late period, the hazard ratios (HRs) for all-cause mortality decreased with earlier VA creation (adjusted HRs [95% confidence intervals]: 0.49 [0.35-0.67] for the early creation group and 0.63 [0.51-0.79] for the just prior creation group).

Conclusion: Our study suggests that VA creation at least 1 month before hemodialysis initiation is associated with lower all-cause mortality in the early period, with earlier VA creation resulting in further mortality reduction in the late period.

Keywords: Arterial superficialization; Arteriovenous fistula; Arteriovenous graft; Hemodialysis; Vascular access.

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Conflict of interest statement

N.F. received personal fees from Chugai Pharmaceutical, Kissei Pharmaceutical, Kyowa Kirin, Ono Pharmaceutical, and Sanwa Kagaku Kenkyusho. T.H. received personal fees from Torii, Astellas, Kissei Pharmaceutical, Kyowa Kirin, Ono Pharmaceutical, and Sanwa Kagaku Kenkyusho and grants from Astellas, Torii, Kissei Pharmaceutical, and Kyowa Kirin. I.M. received personal fees from Chugai Pharmaceutical, Kyowa Kirin, and Ono Pharmaceutical. No other authors have any conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Histogram of the duration between the creation of VA and hemodialysis initiation.
Fig. 2.
Fig. 2.
Kaplan-Meier survival curves according to the timing of VA creation. a All-cause mortality. b Infection-related mortality. c Cardiovascular mortality.
See this image and copyright information in PMC

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