Supplementary Material for: Dialysis Access as an Area of Improvement in Elderly Incident Hemodialysis Patients: Results from a Cohort Study from the International Monitoring Dialysis Outcomes Initiative

Background: Commencing hemodialysis (HD) using a
catheter is associated with a higher risk of adverse outcomes, and early
conversion from central-venous catheter (CVC) to arteriovenous
fistula/graft (non-CVC) improves outcomes. We investigated CVC
prevalence and conversion, and their effects on outcomes during the
first year of HD in a multinational cohort of elderly patients. Methods:
Patients ≥70 years from the MONDO Initiative who commenced HD between
2000 and 2010 in Asia-Pacific, Europe, North-, and South-America and
survived at least 6 months were included in this investigation. We
stratified by age (70-79 years [younger] vs. ≥80 years [older]) and
compared access types (at first and last available date) and their
changes. We studied the association between access at initiation and
conversion, respectively, and all-cause mortality using Kaplan-Meier
curve and Cox regression, and predicted the absence of conversion from
catheter to non-CVC using adjusted logistic regression. Results:
In 14,966 elderly, incident HD patients, survival was significantly
worse when using a CVC at all times. In Europe, the conversion frequency
from CVC to non-CVC was higher in the younger fraction. Conversion from
non-CVC to CVC was associated with worsened outcomes only in the older
fraction. Conclusion: These results corroborate the need
for early HD preparation in the elderly HD population. Treatment of
elderly patients who commence HD with a CVC should be planned
considering aspects of individual clinical risk assessment. Differences
in treatment practices in predialysis care specific to the elderly as a
population may influence access care and conversion rate.