Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.jvs.2012.01.063
Title: Comparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients
Authors: Renaud, Claude J 
Pei, Jackie Ho
Lee, Evan JC 
Robless, Peter A 
Vathsala, Anantharaman 
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Peripheral Vascular Disease
Cardiovascular System & Cardiology
VASCULAR ACCESS
ARTERIOVENOUS-FISTULAS
DIALYSIS
PATENCY
POPULATION
MATURATION
FAILURE
Issue Date: 1-Aug-2012
Publisher: MOSBY-ELSEVIER
Citation: Renaud, Claude J, Pei, Jackie Ho, Lee, Evan JC, Robless, Peter A, Vathsala, Anantharaman (2012-08-01). Comparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients. JOURNAL OF VASCULAR SURGERY 56 (2) : 433-439. ScholarBank@NUS Repository. https://doi.org/10.1016/j.jvs.2012.01.063
Abstract: Background: The number of elderly (<65 years) end-stage renal disease (ESRD) patients on hemodialysis is rapidly increasing. Vascular access outcomes remain contradictory and understudied across different elderly populations. We hypothesized age might influence primary autogenous fistula use and outcomes in a predominantly diabetic multiethnic Asian ESRD population. Methods: Demographic and clinical factors affecting fistula patency and maturation were retrospectively compared among patients with incident ESRD aged <65 and <65 years at a single center. Fistula patency was estimated by Kaplan-Meier curves with log-rank test comparison. Results: We analyzed 280 primary fistulas (59% radiocephalic, 33% brachiocephalic, and 8% brachiobasilic) in this cohort consisting of 31.8% aged <65 years, 50% Chinese, 39% Malay, 42% women, and 70% diabetic. One- and 2-year primary and secondary patency in patients aged <65 vs <65 years were comparable: 41.3% vs 36.7% and 28.7% vs 24.4% (P =.547) and 57.7% vs 56.8% and 47.1% vs 47.2% (P =.990). On multivariate analysis, only non-Chinese, dialysis initiation with tunneled catheters, and surgical/endovascular interventions affected fistula survival hazard ratios (HR): 0.622 (95% confidence interval [CI], 0.43-1.00), 0.549 (95% CI, 0.297-0.841), and 2.503 (95% CI, 1.695-3.697), respectively. Nonmaturation and intervention rates were also similar at 56.7% vs 61.8% and 34% vs 32.2% at 3 and 6 months and 0.31 vs 0.36 per access year, respectively (P >.05). Females and tunneled catheters were the only risk factors for nonmaturation (HR, 1.568; 95% CI, 1.148-1.608, and HR, 1.623; 95% CI, 1.400-1.881, respectively). Conclusions: A primary fistula strategy in incident elderly ESRD is feasible and does not result in inferior outcomes. Age should therefore not be a determinant for primary fistula creation. © 2012 Society for Vascular Surgery.
Source Title: JOURNAL OF VASCULAR SURGERY
URI: https://scholarbank.nus.edu.sg/handle/10635/229418
ISSN: 0741-5214
1097-6809
DOI: 10.1016/j.jvs.2012.01.063
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