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Original Article
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Korean J Intern Med. 2026;41(1):152-162. Published online January 1, 2026.
DOI: https://doi.org/10.3904/kjim.2025.141
- Arteriovenous fistulas are associated with superior outcomes in very elderly hemodialysis patients: a nationwide cohort study
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Hyung Duk Kim1, Do Hyoung Kim2, Hyangkyoung Kim3, Hyung-Seok Lee4, Seung Boo Yang5, Seok Joon Shin6, Hoon Suk Park7
, on behalf of the vascular access working group of the Korean Society of Dialysis Access
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1Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
3Department of Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
4Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
5Department of Radiology, Nowon Eulji University Hospital, College of Medicine, Eulji University, Seoul, Korea
6Division of Nephrology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
7Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author: Hoon Suk Park ,Tel: +82-2-2258-2342, Fax: +82-2-2258-5742, Email: cttailor@catholic.ac.kr
- Received: May 7, 2025; Revised: August 17, 2025 Accepted: September 2, 2025.
- Abstract
- Background/Aims
The 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.
Methods
We 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.
Results
Among 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).
Conclusions
In 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.
Keywords :Arteriovenous fistula; Surgical arteriovenous shunt; Renal dialysis; Aged, 80 and over; Mortality
