Age Based Outcomes of Autogenous Fistulas for Hemodialysis Access.

Abstract Introduction Hemodialysis (HD) dependence and autogenous fistula use for HD span the spectrum of age. This study examines age related outcomes of autogenous fistulas for hemodialysis access in a large population-based cohort of patients. Methods A retrospective cohort study of all patients who initiated hemodialysis in the United States Renal Database System (2007-2014). Chi-square, T-tests, Kaplan-Meier, log-rank tests, multivariable logistic and Cox regression analyses were employed to evaluate access maturation, interventions, patency, and mortality. Results Of the 303281 patients studied, 48892 (16.1%) were younger than 50 years, 55817 (18.4%) were 50-59 years, 79138 (26.1%) were 60-69 years, 75200 (24.8%) were 70-79 years and 44234 (14.6%) were 80 years or older. There was a decrease in autogenous fistula maturation with increasing age. Primary patency at 5 years comparing patients Conclusions In this population-based cohort of hemodialysis patients, there was a decrease in autogenous fistula maturation, primary patency, primary assisted patency, secondary patency and patient survival with increasing age. Despite the relative decline in outcomes associated with older age, decisions about AV access creation in older patients should be individualized taking overall clinical status and outcomes of alternatives modes of access into consideration.