Abstract
Background: Commencing hemodialysis (HD) using a catheter is associated with a higher risk of adverse outcomes, and early conversion from central-venous catheter (CVC) to arteriovenous fistula/graft (non-CVC) improves outcomes. We investigated CVC prevalence and conversion, and their effects on outcomes during the first year of HD in a multinational cohort of elderly patients. Methods: Patients >= 70 years from the MONDO Initiative who commenced HD between 2000 and 2010 in Asia-Pacific, Europe, North-, and South-America and survived at least 6 months were included in this investigation. We stratified by age (70-79 years [younger] vs. >= 80 years [older]) and compared access types (at first and last available date) and their changes. We studied the association between access at initiation and conversion, respectively, and all-cause mortality using Kaplan-Meier curve and Cox regression, and predicted the absence of conversion from catheter to non-CVC using adjusted logistic regression. Results: In 14,966 elderly, incident HD patients, survival was significantly worse when using a CVC at all times. In Europe, the conversion frequency from CVC to non-CVC was higher in the younger fraction. Conversion from non-CVC to CVC was associated with worsened outcomes only in the older fraction. Conclusion: These results corroborate the need for early HD preparation in the elderly HD population. Treatment of elderly patients who commence HD with a CVC should be planned considering aspects of individual clinical risk assessment. Differences in treatment practices in predialysis care specific to the elderly as a population may influence access care and conversion rate. (C) 2017 S. Karger AG, Basel
Original language | English |
---|---|
Pages (from-to) | 486-496 |
Number of pages | 11 |
Journal | American Journal of Nephrology |
Volume | 45 |
Issue number | 6 |
DOIs | |
Publication status | Published - 2017 |
Keywords
- Elderly
- Treatment patterns
- International cohort
- Hemodialysis
- Vascular access
- All-cause mortality
- Predialysis care
- Hemodialysis initiation
- CHRONIC KIDNEY-DISEASE
- VASCULAR ACCESS
- UNITED-STATES
- FISTULA 1ST
- MORTALITY
- OCTOGENARIANS
- EPIDEMIOLOGY
- AGE