{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T12:54:28Z","timestamp":1793192068202,"version":"4.5.0"},"reference-count":31,"publisher":"Korean Association of Internal Medicine","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Korean society of dialysis access"}],"content-domain":{"domain":["kjim.org"],"crossmark-restriction":true},"short-container-title":["Korean J Intern Med"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:p>Background\/Aims: The optimal vascular access strategy for very elderly patients initiating hemodialysis (HD) remains unclear. Arteriovenous fistulas (AVFs) offer long-term benefits but may be limited due to vascular aging. This study evaluated vascular access outcomes in patients aged \u2265 80 years.Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service between 2008 and 2019. Patients aged \u2265 80 years who initiated HD with a newly created AVF or arteriovenous graft (AVG) were included. Primary outcomes were primary, assisted primary, and secondary patency. The secondary outcome was all-cause mortality. Outcomes were compared using Kaplan\u2013Meier analysis and multivariable Cox regression.Results: Among 8,487 patients, 5,124 (60.4%) received AVFs (AVF group) and 3,363 (39.6%) received AVGs (AVG group). AVFs were associated with significantly lower rates of patency loss across all definitions. The adjusted hazard ratios (HRs) for AVG vs. AVF were 1.76 (95% confidence interval [CI], 1.67\u20131.86) for primary patency loss, 1.90 (95% CI, 1.77\u20132.03) for assisted primary, and 3.18 (95% CI, 2.81\u20133.61) for secondary patency loss. All-cause mortality was also higher in the AVG group (adjusted HR, 1.24; 95% CI, 1.17\u20131.30).Conclusions: In this large-scale study, AVF use was associated with superior patency and lower mortality compared with AVG in patients aged \u2265 80 years. These findings suggest that AVF remains a beneficial option for appropriately selected elderly patients and that age alone should not be a primary barrier to its creation.<\/jats:p>","DOI":"10.3904\/kjim.2025.141","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T08:32:08Z","timestamp":1767342728000},"page":"152-162","update-policy":"https:\/\/doi.org\/10.3904\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Arteriovenous fistulas are associated with superior outcomes in very elderly hemodialysis patients: a nationwide cohort study"],"prefix":"10.3904","volume":"41","author":[{"given":"Hyung Duk","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do 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