Dialysis access is critical for therapy delivery. Few studies have linked type of
dialysis access to patient survival in the elderly population.
We included 1995 to 1997 incidence Medicare hemodialysis patients (N = 66,595) who
were 67 years and older at dialysis therapy initiation. Medicare Physician/Supplier
claims were used to determine initial access type: simple fistula, autologous vein
graft, synthetic graft, and hemodialysis catheter. We used International Classification
of Diseases, Ninth Revision, Clinical Modification, codes to determine vascular access
placement for renal failure. A Cox regression analysis assessed risk for death within
1 year, with explanatory variables of incidence year, age, sex, race, diabetes, initial
access type, body mass index, days from first access placement date to initial dialysis
date, and serum albumin, creatinine, and blood urea nitrogen levels.
One-year crude death rates were 24.9%, 27.2%, 28.1%, and 41.5% for patients with simple
fistulae, autologous vein grafts, synthetic grafts, and hemodialysis catheters, respectively.
Patients with simple fistulae (the reference) had the lowest (P < 0.0001) likelihood
of death compared with those with synthetic grafts (hazard ratio [HR], 1.160; 95%
confidence interval [CI], 1.084 to 1.241) or catheters (HR, 1.696; 95% CI, 1.593 to
1.806). No difference (P > 0.09) in mortality risk was detected between simple fistulae
and autologous vein grafts or between autologous vein grafts and synthetic grafts.
In the US Medicare dialysis population, type of initial hemodialysis access was associated
with 1-year mortality. Mortality risks were (in ascending order) fistulae, grafts,
and catheters.