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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Vascular access selection for octogenarians on in-center hemodialysis (HD) is contentious. While the KDOQI Life-Plan advocates patient-first, goal-concordant choices, high frailty prevalence, limited life expectancy, and peri-operative risk complicate arteriovenous (AV) access planning. We quantified mortality across access types in a large, contemporary network to inform catheter-minimizing strategies that still respect the realities of advanced age and frailty.
Retrospective cohort across 103 DaVita Brazil clinics (January 2024–August 2025). Eligible patients were aged ≥80 years receiving conventional ambulatory HD (HDF/PD/AKI excluded). Exposure was access‑at‑risk categorized as: short‑term non‑tunneled catheter (CVC‑ST), long‑term tunneled catheter (CVC‑LT), and AVF/AVG (native fistula or PTFE graft). The primary outcome was all‑cause mortality. We calculated deaths per 100 patient‑years (PY) and estimated incidence rate ratios (IRR) with 95% confidence intervals vs AVF/AVG using Poisson/negative binomial models with log person‑time offset, robust standard errors, and facility random effects. Sensitivity analyses excluded the first 30 days (early‑start bias) and probed overdispersion. Two‑sided statistical significance was prespecified at p<0.05.
Mean monthly census was 1,056 octogenarians, yielding 1,760 PY and 640 deaths over 20 months (~1.67 years). Overall mortality was 36.4 per 100 PY (annualized 36.4%). By access, mortality rates (per 100 PY) were 82.2 for CVC‑ST (73 patients/month; 100 deaths), 38.7 for CVC‑LT (527; 340 deaths), and 24.1 for AVF/AVG (448; 180 deaths) — annualized 82.2%, 38.7%, and 24.1%, respectively. Relative to AVF/AVG, mortality was higher with CVC‑ST (IRR 3.41, 95%CI 2.67–4.35) and with CVC‑LT (IRR 1.61, 95%CI 1.34–1.92); both comparisons met the pre‑specified threshold (p<0.05). Findings were directionally stable after excluding the first 30 days and with facility random effects. At the network level, PAF ≈32% indicates that—if the current case‑mix experienced an AVF/AVG‑like risk—approximately one‑third of deaths associated with catheter exposure might be avoidable.
In a national, real-world cohort of Brazilian octogenarians on conventional HD, mortality differed markedly by vascular access, peaking with short-term catheters and remaining significantly higher with tunneled catheters compared with AVF/AVG. These results reinforce catheter-minimizing care pathways even in advanced age, while acknowledging that frailty may blunt AVF maturation and increase peri-operative risk. A pragmatic, patient-centered strategy is to embed routine frailty screening (e.g., CFS/RAI) into Life-Plan discussions, consider AVG in highly frail patients to accelerate cannulation and shorten catheter time, and deploy an access governance bundle (surgeon/center selection, ultrasound mapping, assisted maturation, early-cannulation protocols, and infection-prevention). Future work should integrate standardized frailty metrics and cause-specific mortality to refine access selection thresholds for the very old.
