Hyangkyoung Kim, Hoon Suk Park, Tae Hyun Ban, Seung Boo Yang, Young joo Kwon, the vascular access working group of the Korean Society of Dialysis Access
{"title":"基于国民健康保险服务数据库的韩国老年人永久性血管通路的结果评估","authors":"Hyangkyoung Kim, Hoon Suk Park, Tae Hyun Ban, Seung Boo Yang, Young joo Kwon, the vascular access working group of the Korean Society of Dialysis Access","doi":"10.1111/hdi.13077","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all <i>p</i> values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (<i>p</i> < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; <i>p</i> < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; <i>p</i> < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; <i>p</i> < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; <i>p</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.</p>\n </section>\n </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"27 3","pages":"249-258"},"PeriodicalIF":1.2000,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database\",\"authors\":\"Hyangkyoung Kim, Hoon Suk Park, Tae Hyun Ban, Seung Boo Yang, Young joo Kwon, the vascular access working group of the Korean Society of Dialysis Access\",\"doi\":\"10.1111/hdi.13077\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all <i>p</i> values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (<i>p</i> < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; <i>p</i> < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; <i>p</i> < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; <i>p</i> < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; <i>p</i> < 0.001).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. 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Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database
Introduction
As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.
Methods
In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.
Results
Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all p values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (p < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; p < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; p < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; p < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; p < 0.001).
Conclusion
Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.
期刊介绍:
Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis.
The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.