Outcomes of vascular access in hemodialysis patients: Analysis based on the Korean National Health Insurance Database from 2008 to 2016

다국어 초록 (Multilingual Abstract)

Background: Controversies exist whether arteriovenous fistula (AVF) placement is preferred over arteriovenous graft (AVG) for elderly patients. Current guidelines did not offer specific recommendations. Thus, this study was conducted to analyze the all-cause mortality and primary patency associated with various vascular access (VA) types according to age group.
Methods: This retrospective observational study investigated the Korean insurance claims data of chronic kidney disease patients who began hemodialysis between January 2008 and December 2016. We investigated all-cause mortality associated with initial VA in incident hemodialysis patients and primary patency between AVF and AVG according to age group.
Results: The proportion of patients with a tunneled dialysis catheter (TDC) that was first placed for VA increased from 18.4% in 2008 to 52.3% in 2016. Incident hemodialysis patients with a TDC or AVG for the initial VA had significantly higher mortality risk than patients with an AVF, except for patients over 85 years, who showed no significant difference in all-cause mortality regardless of VA type. In the patency analysis on initial AV access, AVG had significantly poorer primary patency than AVF in all age groups.
Conclusion: AVF had better patency than AVG in all age groups; however, the benefit of AVF attenuated in the older age groups. The mortality rate between AVF and AVG was not significantly different in patients over 85 years.
Therefore, a “patient-first” approach should be emphasized over a “fistula-first” approach in AV access creation for incident hemodialysis patients older than 85 years.

참고문헌 (Reference)

1 진동찬, "우리나라 말기신부전 환자의 투석현황" 대한의사협회 56 (56): 562-568, 2013

2 Lok CE, "Vascular access morbidity and mortality : trends of the last decade" 8 : 1213-1219, 2013

3 Polkinghorne KR, "Vascular access and all-cause mortality : a propensity score analysis" 15 : 477-486, 2004

4 Saran R, "US Renal Data System 2017 Annual Data Report: Epidemiology of Kidney Disease in the United States" 71 (71): A7-, 2018

5 Astor BC, "Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study" 16 : 1449-1455, 2005

6 Kramer A, "The European Renal Association-European Dialysis and Transplant Association(ERA-EDTA)registry annual report 2015 : a summary" 11 : 108-122, 2018

7 Richardson AI 2nd, "Should fistulas really be first in the elderly patient" 10 : 199-202, 2009

8 Statistics Korea, "Korean Standard Classification of Diseases" Statistics Korea

9 Viecelli AK, "Hemodialysis vascular access in the elderly-getting it right" 95 : 38-49, 2019

10 DeSilva RN, "Fistula first is not always the best strategy for the elderly" 24 : 1297-1304, 2013

11 Ravani P, "Examining the association between hemodialysis access type and mortality : the role of access complications" 12 : 955-964, 2017

12 Allon M, "Dialysis fistula or graft : the role for randomized clinical trials" 5 : 2348-2354, 2010

13 Hyung Seok Lee, "Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database" Korean Association of Internal Medicine 33 (33): 1160-1168, 2018

14 Lok CE, "Cumulative patency of contemporary fistulas versus grafts(2000-2010)" 8 : 810-818, 2013

15 Park HS, "Comparison of outcomes with arteriovenous fistula and arteriovenous graft for vascular access in hemodialysis : a prospective Cohort Study" 43 : 120-128, 2016

16 Vascular Access 2006 Work Group, "Clinical practice guidelines for vascular access" 48 (48): S176-S247, 2006

17 United States Renal Data System, "2014 USRDS annual data report: End-stage Renal Disease (ESRD) in the United States" National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases 2014