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논문분류	춘계학술대회 초록집
제목	The Impact of Comorbidity Index on The Association between Vascular Access type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis
저자	Jong Hyun Jhee, Seoung Woo Lee
출판정보	2019; 2019(1):
키워드	Vascular access \| arteriovenous fistula \| ; arteriovenous graft \| elderly \| charlson comorbidity index
초록	This study aimed to evaluate the impact of comorbidity burden on the association between vascular access type and mortality risk among elderly patients maintaining hemodialysis. A total of 23,100 patients with ≥65 years undergoing hemodialysis were recruited from the Korean end-stage renal disease registry data (2001-2018). Study subjects were stratified into tertile according to Charlson comorbidity index (CCI; 4-5, 6, and ≥7) and compared the survival and hospitalization rate among the type of vascular access. The prevalence of arteriovenous fistula (AVF) use was lower, whereas that of arteriovenous graft (AVG) and central venous catheter (CVC) use was higher in the highest tertile of CCI compared to lowest tertile. During a median follow-up of 4.5 years, 4,405 (19.1%) of death, 1,061 (4.6%) of hospitalization due to access malfunction, and 180 (0.8%) of hospitalization due to access infection had occurred. Among all tertiles of CCI, the use of CVC showed highest risk for mortality compared to use of AVF. In the lowest tertile, the survival rate between the use of AVF and AVG showed no difference. However, in middle and highest tertiles, subjects with AVG showed significantly higher risk of mortality compared to those with AVF. When the subjects were classified according to combination of CCI tertile and the type of access (AVF vs. AVG), the highest tertile of CCI with use of AVG showed the highest risk for mortality compared to those with lowest tertile of CCI using AVF (hazard ratio, 1.75; 95% confidence interval, 1.28-2.39). The hospitalization risks due to access malfunction or infection were higher in patients with AVG or CVC than AVF in higher tertiles of CCI compared to the lowest tertile. The use of AVF may be beneficial and switching to AVF should be considered in the elderly with high burden of comorbidity maintaining hemodialysis.
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