Evaluation of Disparate Vascular Accesses in Elderly Chinese Patients on Maintenance Hemodialysis: A Ten-Year Retrospective Study

Background and Objectives: The rising prevalence of end-stage renal disease (ESRD) among elderly Chinese patients necessitates evaluating vascular access methods-CVC, AVF, and AVG-for hemodialysis (HD). This study aims to assess their effectiveness in terms of mortality, survival, and hospitalization, and to determine the optimal access strategy, particularly for older and diabetic patients. Methods: A retrospective study of 126 hemodialysis patients aged >= 75 years (2010-2020) categorized into AVF, AVG, and CVC groups. Outcomes assessed included mortality, survival time, and hospitalization, with subgroup analysis by age and diabetes. Differences between groups were analyzed using one-way ANOVA or chi-square tests, and survival was evaluated with Kaplan-Meier curves and Log-Rank test. Results: Mean survival times were 98.4 months (95% CI, 62.7-134.2) for AVG, 84.6 months (95% CI, 47.8-119.5) for AVF, and 33.5 months (95% CI, 24.2-42.8) for CVC. Survival rates were significantly higher in AVF and AVG versus CVC overall and in non-diabetic patients (P < 0.05). No significant differences were found in patients aged >= 80 or with diabetes (P > 0.05). Conclusion: For patients aged 75 and older, AVF is the preferred vascular access, with AVG as an alternative if AVF is not feasible. In patients aged 80+ with comorbidities, CVC may be considered when other options are unsuitable, as no survival differences were found. These findings highlight the need for personalized treatment strategies, considering age, comorbidities, and AVF maturation potential..