대한신장학회

논문분류	춘계학술대회 초록집
제목	Central Venous Catheter as a Permanent Vascular Access Should Be Avoided Even in the Very Elderly Dialysis Population: A Retrospective Study Using NHIS Data
저자	Joo Un Park
출판정보	2025; 2025(1):
키워드	Central Venous Catheter , Arteriovenous fistula , Arteriovenous graft , Very Elderly Dialysis Patients, Hemodialysis
초록	The number of elderly dialysis patients is increasing, but establishing permanent vascular access remains challenging. Consequently, data on optimal vascular access for elderly, particularly very elderly individuals such as octogenarians (≥ 80 years) or nonagenarians (≥ 90 years), are limited. This study analyzes the mortality rates by permanent vascular access across different age groups to identify the best strategies for these populations. This is a retrospective cohort study using data from the Korean National Health Insurance Service (NHIS). A total of 79,286 patients who initiated maintenance hemodialysis with vascular access placement between January 1, 2012, and December 31, 2021, were included. Survival rates were compared between patients using a central venous catheter (CAT) and those utilizing an arteriovenous fistula (AVF) and graft (AVG). Patients were stratified by age groups. The arteriovenous access(AVF and AVF) group significantly showed the better survival rates compared to CAT group across all age groups(Fig. 1). The adjusted hazard ratios (HR) for CAT compared to AVF were 4.413 (4.033-4.828), 3.620 (3.461-3.787), 3.300 (3.138-3.471), and 3.181 (2.651-3.817) in the age groups of 65–69, 70–79, 80–89, and ≥90years, respectively (all p<0.001). Similary, the hazard ratios for CAT were higher compared to AVG, with values of 2.789 (2.511-3.098), 2.633 (2.500-2.773), 2.610 (2.469-2.760), and 2.554 (2.100-3.107) in the respective age groups (all p<0.001) (Table 1). The use of CAT as a permanent vascular access was associated with poorer patient survival compared to AVF or AVG across all age groups, including octogernarian and even nonagenarian populations. Therefore, CAT should only be considered as a permanent vascular access option in extremely limited cases where patient survival expectancy is severely restricted due to multiple comorbidities. Age should not be regarded as a limiting factor for establishing arteriovenous HD access and does not justify a catheter-dependent state.
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