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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.
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In very old adults on conventional in-center hemodialysis (HD), vascular-access choice must balance surgical burden and maturation failures against infection and hospitalization risk. We quantified hospitalization burden by access type among octogenarians.
We conducted a retrospective cohort analysis of all patients aged ≥80 years undergoing conventional outpatient hemodialysis at 103 DaVita Brasil clinics between January 2024 and August 2025. Data were extracted from the national clinical dashboard and grouped by vascular‑access type: all accesses, short‑term central venous catheters (CVC), long‑term CVCs, and arteriovenous (AV) fistulas (including PTFE grafts). For each group we calculated monthly averages of total patients, hospitalized patients, total hospitalizations and hospital‑stay length. The mean monthly cohort size was ≈1 060 patients across the 20‑month window.
Hospitalization burden was expressed as events per patient‑year ((mean monthly hospitalizations ÷ mean monthly patients) × 12). To test whether differences in hospitalization rates between access types were greater than would be expected by chance, we used two‑sample tests of equality of Poisson rates (implemented via test_poisson_2indep in the statsmodels package). Event counts (total hospitalizations over 20 months) and exposure (patient‑months = mean monthly patients × 20) were computed for each comparison. Differences were deemed significant for p < 0.05.
During the 20‑month period the cohort averaged 1 060 patients. Overall, 53 patients were hospitalized per month and the mean hospitalization rate was 5.0 % with 59 hospitalizations per month; this corresponds to 0.67 hospitalizations per patient‑year. Short‑term CVCs were used by 47 patients on average; this group had the highest hospitalization burden with 11.5 % of patients hospitalized monthly and 6 hospitalizations per month (1.53 events per patient‑year). Long‑term CVC users (n≈499) showed an intermediate hospitalization rate of 6.0 % and 34 hospitalizations per month (0.82 events per patient‑year). Patients dialyzing via AV fistula or PTFE graft (n≈513) had the lowest hospitalization burden—3.4 % hospitalized monthly and 19 hospitalizations per month (0.44 events per patient‑year). Length of stay was similar across groups (≈18–19 days).
Rate‑ratio testing showed that the differences in hospitalization burden between groups were highly significant. Compared with fistula/graft users, patients with short‑term CVCs experienced a more than three‑fold higher rate of hospitalization (rate ratio ≈3.4) and those with long‑term CVCs experienced nearly double the hospitalization rate; the resulting p‑values were <0.001 for each comparison. The difference between short‑ and long‑term CVCs was also significant (p < 0.001), while the aggregate “all access” group likewise differed significantly from the fistula/graft group. These findings indicate that higher hospitalization burden is not attributable to random variation but reflects true differences associated with access type.
In a large Brazilian cohort of patients aged ≥80 years on conventional hemodialysis, short‑term CVC use was associated with the highest hospitalization burden (1.53 events per patient‑year), while AV fistulas/grafts had the lowest burden (0.44 events per patient‑year). These data, together with emerging evidence that frailty and life expectancy modify the benefits and risks of vascular‑access types, support a patient‑centered approach to vascular‑access selection in the oldest‑old. Clinicians should evaluate frailty, comorbidity and anticipated survival when deciding whether to pursue fistula creation or maintain catheter/graft access, aiming to minimize hospitalizations and improve quality of life.
