Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.jvs.2012.01.063
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dc.titleComparative outcomes of primary autogenous fistulas in elderly, multiethnic Asian hemodialysis patients
dc.contributor.authorRenaud, Claude J
dc.contributor.authorPei, Jackie Ho
dc.contributor.authorLee, Evan JC
dc.contributor.authorRobless, Peter A
dc.contributor.authorVathsala, Anantharaman
dc.date.accessioned2022-07-29T06:44:23Z
dc.date.available2022-07-29T06:44:23Z
dc.date.issued2012-08-01
dc.identifier.citationRenaud, 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
dc.identifier.issn0741-5214
dc.identifier.issn1097-6809
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/229418
dc.description.abstractBackground: 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.
dc.language.isoen
dc.publisherMOSBY-ELSEVIER
dc.sourceElements
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectSurgery
dc.subjectPeripheral Vascular Disease
dc.subjectCardiovascular System & Cardiology
dc.subjectVASCULAR ACCESS
dc.subjectARTERIOVENOUS-FISTULAS
dc.subjectDIALYSIS
dc.subjectPATENCY
dc.subjectPOPULATION
dc.subjectMATURATION
dc.subjectFAILURE
dc.typeArticle
dc.date.updated2022-07-23T08:02:53Z
dc.contributor.departmentDEPT OF MEDICINE
dc.contributor.departmentDEPT OF SURGERY
dc.contributor.departmentMEDICINE
dc.description.doi10.1016/j.jvs.2012.01.063
dc.description.sourcetitleJOURNAL OF VASCULAR SURGERY
dc.description.volume56
dc.description.issue2
dc.description.page433-439
dc.description.placeUnited States
dc.published.statePublished
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