{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:23:37Z","timestamp":1790627017355,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100017317","name":"Catholic Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017317","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>As nearly half of patients with end\u2010stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65\u2009years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients \u226565\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (\u2265\u200965\u2009years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Elderly AVF group (n\u00a0=\u00a028,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n\u00a0=\u00a013,522) (all <jats:italic>p<\/jats:italic> values are &lt;0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all\u2010cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272\u20131.343; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701\u20131.790; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), primary\u2010assisted patency (adjusted HR: 2.163; 95% CI: 2.095\u20132.233; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533\u20133.913; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (\u2265\u200965\u2009years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hdi.13077","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T16:05:20Z","timestamp":1679414720000},"page":"249-258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2021-815X","authenticated-orcid":false,"given":"Hyangkyoung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Surgery Ewha Womans University College of Medicine, Ewha Womans University Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoon Suk","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine The Catholic University of Korea School of Medicine  Seoul Republic of Korea"},{"name":"Department of Internal Medicine The Catholic University of Korea School of Medicine\/Eunpyeong St. Mary's Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae Hyun","family":"Ban","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine The Catholic University of Korea School of Medicine  Seoul Republic of Korea"},{"name":"Department of Internal Medicine The Catholic University of Korea School of Medicine\/Eunpyeong St. Mary's Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Boo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology Soonchunhyang University Gumi Hospital  Gumi Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young joo","family":"Kwon","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine Korea University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the vascular access working group of the Korean Society of Dialysis 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