Dialysis Access as an Area of Improvement in Elderly Incident Hemodialysis Patients: Results from a Cohort Study from the International Monitoring Dialysis Outcomes Initiative

作者：Raimann Jochen G^*; Barth Claudia; Usvyat Len A; Preciado Priscila; Canaud Bernard; Etter Michael; Xu Xiaoqi; Guin**urg Adrian; Marelli Christina; Duncan Neill; Power Albert; van der Sande Frank M; Kooman Jeroen P; Thijssen Stephan; Wang Yuedong; Kotanko Peter

来源：American Journal of Nephrology, 2017, 45(6): 486-496.

DOI：10.1159/000476003

• Elderly
• Treatment patterns
• International cohort
• Hemodialysis
• Vascular access
• All-cause mortality
• Predialysis care
• Hemodialysis initiation

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.

• 出版日期2017