Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study

Park, Joo Un; Park, Chang Min; Kim, Do Hyoung; Kim, Hyangkyoung; Chung, Byung Ha; Lee, Hyung Seok; Park, Sang Jun; Kim, Min-ho; Park, Hoon Suk

doi:2026.41.5.914

Korean J Intern Med > Volume 41(5); 2026 > Article

ORIGINAL ARTICLE

Korean J Intern Med. 2026;41(5):914-926. doi: https://doi.org/10.3904/kjim.2025.343

Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study

Joo Un Park¹, Chang Min Park², Do Hyoung Kim³, Hyangkyoung Kim⁴, Byung Ha Chung¹, Hyung Seok Lee⁵, Sang Jun Park⁶, Min-ho Kim⁷

, and Hoon Suk Park¹

¹Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
²Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
³Division of Nephrology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
⁴Division of Vascular Surgery, Department of Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
⁵Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
⁶Division of Vascular Surgery, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
⁷Ewha Medical Data Organization, Ewha Womans University Seoul Hospital, Seoul, Korea

Corresponding Author: Min-ho Kim , Tel: +82-2-6986-1869, Fax: +82-2-6986-5802, Email: mino-kim@naver.com
Hoon Suk Park , Tel: +82-2-1588-1511, Fax: +82-2-594-7230, Email: cttailor@catholic.ac.kr

Received: October 2, 2025; Revised: April 9, 2026; Accepted: May 11, 2026.

Abstract

Background/Aims: Owing to aging-related factors, arteriovenous access (AV) is difficult to establish in older patients; central venous catheter (CVC) access is used instead. However, evidence on long-term outcomes of permanent vascular access types in the oldest-old adults (≥ 80 yr) is lacking. We aimed to compare mortality by vascular access type in older Korean patients undergoing hemodialysis.
Methods: This nationwide retrospective cohort study included 79,286 adult patients who initiated maintenance hemodialysis between 2012 and 2021, identified from the Korean National Health Insurance Service database. Patients were categorized by permanent vascular access type (AV fistula [AVF], AV graft [AVG], or CVC). Kaplan–Meier survival analysis and Cox proportional hazards models were used to assess mortality across vascular access types. Analyses were stratified by age group.
Results: CVC access was associated with the highest mortality. Compared with AVF use, CVC use was associated with more than a threefold increase in mortality risk (aHR 3.54; 95% CI, 3.43–3.65). Though attenuated, the CVC use-associated mortality risk remained significantly elevated in octogenarians and nonagenarians (aHR 3.30; 95% CI, 3.14–3.47 and aHR 3.18; 95% CI, 2.65–3.82, respectively). Compared with AVG use, CVC use remained consistently associated with elevated mortality risk across age groups.
Conclusions: CVC use as permanent access was associated with increased mortality, even among the oldest-old. Advanced age should be regarded as a clinical consideration rather than a definitive contraindication to AV access. Our findings support the need for individualized clinical decision-making, even in the oldest-old population.

Keywords: Arteriovenous shunt, surgical ; Central venous catheters ; Aged ; Renal dialysis ; Mortality