대한신장학회

논문분류	춘계학술대회 초록집
제목	Association between Clinical Outcomes and Vascular Access in Elderly End-stage Renal Disease Patients Initiating Hemodialysis
저자	Kyoung Sook Park1, Youn Kyung Kee1, Chang-Yun Yoon1, In Mee Han1, Seung Gyu Han1, Young Eun Kwon1, Mi Jung Lee1, Jung Tak Park1, Seung Hyeok Han1, Tae-Hyun Yoo1, Yong-Lim Kim2, Yon Su Kim3, Chul Woo Yang4, Nam-Ho Kim5, Shin-Wook Kang1
출판정보	2015; 2015(1):
키워드	혈액투석,동정맥루,노인
초록	Backgrounds: Although planned creation of arteriovenous fistula (AVF) is best strategy in end-stage renal disease (ESRD) patients at dialysis initiation, elderly patients are compelled to use other vascular access due to underlying vascular problems and maturation failure. Recent study showed that patients with arteriovenous graft (AVG) had comparable outcomes those with AVF, despite of still high proportion of use of hemodialysis catheter (HC) in elderly incident dialysis population. Therefore, we investigated the association of vascular access type and clinical outcome in elderly HD patients. Methods: A prospective cohort of incident hemodialysis (HD) patients from 36 dialysis centers of the Clinical Research Center for ESRD in Korea between August 1, 2009 and December 31, 2013 was used. Patients 65 or older were included for analysis. Study subjects were classified into three groups according to type of vascular access at the time of dialysis initiation. Since the hazard ratio (HR) according to type of vascular access was not proportional, time-dependent Cox regression analysis was performed to determine all-cause mortality. Results: Of the 511 enrolled patients, 303 (59.3%) were male and the mean age was 72.3±5.4 years. Dialysis was initiated with AVF, AVG, or HC in 86 (16.8%), 36 (7.0%), and 389 (76.1%) patients, respectively. During a median 12 month follow up, all-cause death events were observed 12 (14.0%) in AVF, 13 (36.1%) in AVG, and 107 (27.5%) in HC. In univariate time-dependent Cox regression analysis, AVG (HR=1.775, 95% confidence interval [CI]= 1.326-2.375, p<0.001) and HC (HR=1.387, 95% CI=1.107-1.737, p=0.004) were significantly associated with increased risk of all-cause mortality compared to AVF. Furthermore, multivariate analysis showed that AVG (AVF as reference, HR=1.719, 95% CI=1.274-2.319, p<0.001) and HC (HR=1.304, 95% CI=1.036-1.640, p=0.023) were still significant risk factors for all-cause mortality even after adjustment of age, sex, diabetes mellitus, previous cardiovascular disease, timing of referral to nephrologist, hemoglobin, serum albumin, and C-reactive protein levels. Conclusion: Patients with successful AVF are associated with better survival rates compared to those with AVG and HC. And AVG is not superior to HC in clinical outcomes in elderly HD population. Although the elderly ESRD patients have more vascular problems for delayed maturation, AVF is the best strategy for improvement of patient mortality in incident HD.
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