Evidence map›Paper›PMID 41531223›Full record

ArticleThe Korean journal of internal medicine2026

Arteriovenous fistulas are associated with superior outcomes in very elderly hemodialysis patients: a nationwide cohort study.

Hyung Duk Kim, Do Hyoung Kim, Hyangkyoung Kim, Hyung-Seok Lee, Seung Boo Yang, Seok Joon Shin, Hoon Suk Park, vascular access working group of the Korean Society of Dialysis Access

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Article in The Korean journal of internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

8 authors.

Hyung Duk KimDivision of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Do Hyoung KimDivision of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Hyangkyoung KimDepartment of Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea.
Hyung-Seok LeeDivision of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Seung Boo YangDepartment of Radiology, Nowon Eulji University Hospital, College of Medicine, Eulji University, Seoul, Korea.
Seok Joon ShinDivision of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Hoon Suk ParkDivision of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
vascular access working group of the Korean Society of Dialysis AccessDivision of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Funding

Korean society of dialysis access
6 · The paper itself

Abstract

BACKGROUND/

aimsThe optimal vascular access strategy for very elderly patients initiating hemodialysis (HD) remains unclear. Arteriovenous fistulas (AVFs) offer long-term benefits but may be limited due to vascular aging. This study evaluated vascular access outcomes in patients aged ≥ 80 years.

methodsWe conducted a retrospective cohort study using data from the Korean National Health Insurance Service between 2008 and 2019. Patients aged ≥ 80 years who initiated HD with a newly created AVF or arteriovenous graft (AVG) were included. Primary outcomes were primary, assisted primary, and secondary patency. The secondary outcome was all-cause mortality. Outcomes were compared using Kaplan-Meier analysis and multivariable Cox regression.

resultsAmong 8,487 patients, 5,124 (60.4%) received AVFs (AVF group) and 3,363 (39.6%) received AVGs (AVG group). AVFs were associated with significantly lower rates of patency loss across all definitions. The adjusted hazard ratios (HRs) for AVG vs. AVF were 1.76 (95% confidence interval [CI], 1.67-1.86) for primary patency loss, 1.90 (95% CI, 1.77-2.03) for assisted primary, and 3.18 (95% CI, 2.81-3.61) for secondary patency loss. All-cause mortality was also higher in the AVG group (adjusted HR, 1.24; 95% CI, 1.17-1.30).

conclusionIn this large-scale study, AVF use was associated with superior patency and lower mortality compared with AVG in patients aged ≥ 80 years. These findings suggest that AVF remains a beneficial option for appropriately selected elderly patients and that age alone should not be a primary barrier to its creation.

Indexed as

Arteriovenous Shunt, SurgicalKidney Failure, ChronicRenal DialysisAged, 80 and overAge FactorsFemaleGraft Occlusion, VascularHumansMaleRepublic of KoreaRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeVascular PatencyAged, 80 and overArteriovenous fistulaMortalityRenal dialysisSurgical arteriovenous shunt

Identifiers

PMID41531223
PMCPMC12800457

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.