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. 2025 Aug;29(8):1063-1074.
doi: 10.1007/s10157-025-02654-3. Epub 2025 Mar 18.

Impact of prepared vascular access on mortality and medical expenses in elderly and non-elderly Japanese patients with chronic kidney disease stage G5: a retrospective cohort study

Takayuki Nimura #  1 , Makoto Harada #  1 , Daiki Aomura  1 , Kosuke Yamaka  1 , Koji Hashimoto  1 , Yuji Kamijo  2
Affiliations

Impact of prepared vascular access on mortality and medical expenses in elderly and non-elderly Japanese patients with chronic kidney disease stage G5: a retrospective cohort study

Takayuki Nimura et al. Clin Exp Nephrol. 2025 Aug.

Abstract

Background: Patients with chronic kidney disease (CKD) stage 5 (CKDG5) have greater dialysis requirements that increase the risk of cardiovascular disease and mortality. The elevated costs associated with CKDG5 are a serious concern. The impact of prepared vascular access (VA) through planned VA creation on mortality and medical expenses remains unclear in Japanese patients with CKDG5.

Methods: We conducted a retrospective cohort study including 157 patients with CKD who started hemodialysis (HD) at Shinshu University Hospital from April 2016 to March 2021 and assessed the relationship between the presence of a prepared VA and mortality and hospitalization expenses in elderly and non-elderly patients with CKDG5.

Results: The presence of a prepared VA was associated with lower mortality in non-elderly patients but not in elderly patients. Medical expenses, emergency HD, and hospitalization duration were significantly lower in patients with a prepared VA in both age groups. The contribution of a prepared VA to mortality and medical expenses remained consistent after adjusting for sex, performance status, comorbidities, and nutritional status.

Conclusion: A prepared VA showed several benefits, including lower mortality rates and hospitalization costs; shorter hospital stays; and higher home discharge rates. Planned VA creation was significantly associated with lower hospitalization expenses, irrespective of age.

Keywords: Elderly patients; Hemodialysis; Hospitalization expenses; Mortality; Vascular access.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors have declared that no conflict of interest exists.

Figures

Fig. 1
Fig. 1
Study flowchart. AKI acute kidney injury, HD hemodialysis, PD peritoneal dialysis, RPGN rapidly progressive glomerulonephritis
Fig. 2
Fig. 2
Comparison of survival rates between patients with and without a prepared VA divided into non-elderly and elderly groups. The survival rate was evaluated using the Kaplan–Meier method and the log-rank test. A Comparison of survival rates among non-elderly patients with CKDG5 with and without a prepared VA. B Comparison of survival rates among elderly patients with CKDG5 with and without a prepared VA. VA vascular access
Fig. 3
Fig. 3
Reasons for lack of VA creation before HD initiation. The pie chart shows the different reasons for the lack of VA creation before HD initiation. HD hemodialysis, VA vascular access
See this image and copyright information in PMC

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