Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study.

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 (≥ 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-Meier 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, 3.43-3.65). Though attenuated, the CVC use-associated mortality risk remained significantly elevated in octogenarians and nonagenarians (aHR 3.30; 95% CI, 3.14-3.47 and aHR 3.18; 95% CI, 2.65-3.82, respectively). Compared with AVG use, CVC use remained consistently associated with elevated mortality risk across age groups. CONCLUSION: 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.