Kidney Week

Abstract: PUB222

Impact of Prepared Vascular Access on Mortality and Medical Expenses in Elderly and Nonelderly Japanese Patients with CKD Stage G5: A Retrospective Cohort Study

Session Information

• Publication Only

Category: Dialysis

• 803 Dialysis: Vascular Access

Authors

• Kamijo, Yuji, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Yuji Kamijo, MD, PhD

• Nimura, Takayuki, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Takayuki Nimura, MS

• Nakayama, Yuki, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Yuki Nakayama, MS

• Aomura, Daiki, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Daiki Aomura, MD, PhD

• Yamaka, Kosuke, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Kosuke Yamaka, MD

• Hashimoto, Koji, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Koji Hashimoto, MD, PhD

• Harada, Makoto, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

Makoto Harada

Background

Patients with chronic kidney disease (CKD) stage 5 (CKDG5) have greater dialysis requirements that increase the risk of cardiovascular disease and mortality. The elevated costs associated with CKDG5 are a serious concern. The impact of prepared vascular access (VA) through planned VA creation on mortality and medical expenses remains unclear in Japanese patients with CKDG5.

Methods

We conducted a retrospective cohort study of 157 patients with CKD who started hemodialysis (HD) at Shinshu University Hospital from April 2016 to March 2021 and analyzed the relationship between the presence of a prepared VA and mortality and hospitalization expenses in elderly and non-elderly patients with CKDG5.

Results

The presence of a prepared VA was associated with lower mortality in non-elderly patients but not in elderly patients. Medical expenses, emergency HD, and hospitalization duration were significantly lower in patients with a prepared VA in both age groups. The contribution of a prepared VA to mortality and medical expenses remained consistent after adjusting for sex, performance status, comorbidities, and nutritional status.

Conclusion

A prepared VA has several benefits; however, the prognostic benefit was not observed in elderly patients with CKDG5. From a prognostic perspective, we should consider patient’s general condition and predicted prognosis in proactive decision-making regarding the selection of renal replacement therapy and VA preparation in elderly patients.