Effects of different types of vascular access on survival of elderly patientson maintenance hemodialysis

Objective To explore the influencing factors of survival in elderly patients on maintenance hemodialysis(MHD) and examine the differences between different vascular access types. Methods A prospective cohort study was conducted for 121 elderly patients on MHD from January 1, 2017 to December 31, 2019. According to the specific type of vascular access, it was divided into 2 groups of arteriovenous fistula (AVF) and tunneled cuffed catheter(TCC). The major observation endpoint was death during 3-years follow-ups. Results They had an average age(71.6±7.7) years. There were 54 diabetic nephropathy(44.6%), 77 males(63.6%), 74 AVF(61.2%) and 47 TCC(38.8%). The mortality rate of AVF group was lower than that of TCC group(40.5%, 30/74 vs 44.7%, 21/47). There was no statistical difference(P>0.05). No significant inter-group difference existed in cause of death ratio(P>0.05). Top 1 cause of death was cardiovascular events and infection in AVF group and infection in TCC group. The cumulative survival rate was higher in AVF group than that in TCC group during 3-year follow-ups. There was no significant difference(P>0.05). Single-factor analysis indicated that gender and albumin were important influencing factors of all-cause death(P<0.05). Multivariate COX regression analysis revealed that, after correcting for primary disease, albumin, gender and age, vascular access was not an independent risk factor for all-cause death(P>0.05). Albumin was an independent protective factor for all-cause death in elderly MHD patients(P<0.05). Conclusion Vascular access type has no direct impact upon survival in elderly MHD patients. Therefore individualized vascular path may be established according to personal wishes of patients. By correcting malnutrition and improving albumin level, the survival rate of patients can be improved.