#2192 Aging dialysis population and late referral: two factors influencing the choice of vascular access

Abstract

Abstract Background and Aims The decision on the type of vascular access for hemodialysis is based on several factors including the timing of renal replacement therapy initiation and certain patients’ clinical and demographic features. We hypothesized that the increasing age of patients on hemodialysis and the issue of "late referral" can be relevant in this context and favor the use of central venous catheter (CVC) over arteriovenous fistula (AVF), with a surge in catheter-related complications. Method We carried out a retrospective observational study of vascular access procedures (AVF creation and long-term CVCs placement) performed at the Nephrology Unit of the “Fondazione Policlinico Universitario Agostino Gemelli” between January 2020 and December 2023. Results A total of 415 procedures for AVF creation (median age 63.5, IQR 55.5 - 71.5 years), of which 59 (14,2%) in “late referral” patients (median age 61, IQR 47.5 - 72.5 years), were performed. During the same period, 343 CVCs were placed, of which 151 (44%) in patients with planned admission as previously evaluated by a nephrologist (median age 69, IQR 60 - 79 years). The remaining 192 CVC placements (56%) involved patients after an emergency admission (median age 69, IQR 57 - 80 years). In 56 (29%) of these patients an AVF was created concurrently or within 60 days from the emergency procedure. Such patients were significantly younger (median age 66, IQR 57 - 73 years) than those who underwent a CVC placement after a planned admission (p=0.01) or others with emergency admission (p=0.03). In a multivariate analysis (logistic regression) the use of CVC over AVF was significantly and independently correlated with both late referral and age. Conclusion These data suggest that the increasing use of CVCs in hemodialysis may be due to the age of incident patients and remark the importance of early evaluation in order to choose the most appropriate vascular access.