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

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.

Dialysis-specific factors and incident atrial fibrillation in hemodialysis patients

“…Lower blood flow rate was found to be a significant factor associated with AF in the regression analysis, but it was not a significant factor associated with AF in the receiver operating characteristic analysis. We believe that inevitable confounding factors might have led to the use of low blood flow rate at the cost of dialysis adequacy such as presence of a central catheter (7.1%, 6/84), poor fistula maturation, or preexisting heart failure [23]. Among the traditional risk factors, lower pre-dialysis blood pressure was associated with a high incidence of AF [24], with the included population older than those of our study.…”

Nefroloji Düşük Klirens Polikliniğinde Arteriovenöz Fistülü Hazır Hemodiyalize Başlamayan Hastalarda Arteriovenöz Fistül Eğitimlerinin Değerlendirilmesi: Pilot Çalışma

“…Patients whose arteriovenous fistulas have been formulated before and are followed up ready should be routinely examined every month, their arteriovenous fistulas should be checked during the examination and training control forms should be created for arteriovenous fistula protection. (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Tüm bu verilerin ışığında düşük klirens polikliniğinde kişiye özel eğitimlerle RRT tercihini HD olarak belirleyen hastalara uygun zamanda AVF açılması için yönlendirme yapılmaktadır.…”

Epidemiological characteristics of cancers in patients with end-stage kidney disease: a Korean nationwide study

“…The KNHIS, the single public health insurance provider in Korea, has been operated by the Ministry for Health and Welfare since July 1989 and covers over 97% of the Korean population. Many previous studies using HIRA data have been published 13 – 15 . We extracted ESKD cohort patient data from the HIRA database including characteristics such as age; sex; diagnoses based on the International Classification of Disease, Revision 10 (ICD-10) codes; intervention procedures, and surgical procedures such as HD, PD, and KT.…”