{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:15:48Z","timestamp":1789460148659,"version":"build-2803163510"},"reference-count":49,"publisher":"Korean Association of Internal Medicine","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Korean society of dialysis access"},{"name":"Catholic Medical Center Research Foundation"}],"content-domain":{"domain":["kjim.org"],"crossmark-restriction":true},"short-container-title":["Korean J Intern Med"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:p>Background\/Aims: Owing to aging-related factors, arteriovenous access (AV) is difficult to establish in older patients; central venous catheter (CVC) access is used instead. However, evidence on long-term outcomes of permanent vascular access types in the oldest-old adults (\u2265 80 yr) is lacking. We aimed to compare mortality by vascular access type in older Korean patients undergoing hemodialysis.Methods: This nationwide retrospective cohort study included 79,286 adult patients who initiated maintenance hemodialysis between 2012 and 2021, identified from the Korean National Health Insurance Service database. Patients were categorized by permanent vascular access type (AV fistula [AVF], AV graft [AVG], or CVC). Kaplan\u2013Meier survival analysis and Cox proportional hazards models were used to assess mortality across vascular access types. Analyses were stratified by age group.Results: CVC access was associated with the highest mortality. Compared with AVF use, CVC use was associated with more than a threefold increase in mortality risk (aHR 3.54; 95% CI, 3.43\u20133.65). Though attenuated, the CVC use-associated mortality risk remained significantly elevated in octogenarians and nonagenarians (aHR 3.30; 95% CI, 3.14\u20133.47 and aHR 3.18; 95% CI, 2.65\u20133.82, respectively). Compared with AVG use, CVC use remained consistently associated with elevated mortality risk across age groups.Conclusions: CVC use as permanent access was associated with increased mortality, even among the oldest-old. Advanced age should be regarded as a clinical consideration rather than a definitive contraindication to AV access. Our findings support the need for individualized clinical decision-making, even in the oldest-old population.<\/jats:p>","DOI":"10.3904\/kjim.2025.343","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T02:15:56Z","timestamp":1788747356000},"page":"927-939","update-policy":"https:\/\/doi.org\/10.3904\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study"],"prefix":"10.3904","volume":"41","author":[{"given":"Joo Un","family":"Park","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Min","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary\u2019s Hospital, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do Hyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyangkyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Ha","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Jun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4909-2308","authenticated-orcid":true,"given":"Min-ho","family":"Kim","sequence":"additional","affiliation":[{"name":"Ewha Medical Data Organization, Ewha Womans University Seoul Hospital, Seoul, 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