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논문분류	춘계학술대회 초록집
제목	Patency and Survival of Forearm versus Upper Arm Arteriovenous Fistula in Elderly Hemodialysis Patients
저자	Chang Min Park
출판정보	2026; 2026(1):
키워드	Arteriovenous fistula, elderly patients, forearm, patency, survival
초록	Objectives: Arteriovenous fistula (AVF) has been considered as the preferred vascular access for hemodialysis because of its superior patency and better survival outcomes. Radiocephalic AVF is generally recommended the first option; however, upper arm AVF (brachiocephalic or brachiobasilic) is frequently chosen in elderly patients with poor vascular conditions. As the mean age of hemodialysis patients has increased, the use of upper arm AVF has also increased. This study aimed to compare patency and patient survival between forearm and upper arm AVF, particularly in elderly patients. Methods: We conducted a retrospective observational study using the Clinical Data Warehouse of the Catholic Medical Center (CMC-CDW) and included patients who underwent vascular access creation between 2015 and 2024. Patients were classified into forearm and upper arm AVF groups. Primary, primary-assisted, and secondary patency and patient survival were compared. Subgroup analyses were performed according to age (65–69, 70–79, 80–89, and ≥90 years). Results: Among 2,205 patients, 1,156 (52.4%) were in the forearm AVF group and 1,049 (47.6%) were in the upper arm AVF group. In multivariate Cox regression analyses, upper arm AVF (vs. forearm AVF) showed no significant differences in primary patency (adjusted hazard ratio [HR], 1.056; 95% confidence interval [CI], 0.895–1.245; P=0.519), primary-assisted patency (HR, 1.344; 95% CI, 0.971–1.861; P=0.075), and secondary patency (HR, 1.021; 95% CI, 0.881–1.183; P=0.785). In the subgroup analysis of elderly patients (≥65 years), primary patency was also not significantly different between the two groups (Table 1). In contrast, upper arm AVF was associated with increased risk of mortality in the overall cohort (HR, 1.517; 95% CI, 1.193–1.927; P<0.001). In Kaplan–Meier analyses by age subgroup, a significant survival difference was identified in patients aged 70–79 years (log-rank P=0.025, Figure 1). Conclusion: Upper arm AVF showed no patency advantage and was associated with higher mortality, particularly in older patients.
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