<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2976-0526</journal-id>
<journal-title><![CDATA[Portuguese Kidney Journal (PKJ)]]></journal-title>
<abbrev-journal-title><![CDATA[PKJ]]></abbrev-journal-title>
<issn>2976-0526</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Nefrologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2976-05262024000300056</article-id>
<article-id pub-id-type="doi">10.71749/pkj.62</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Clinical Outcomes in Very Elderly Patients According to Vascular Access at Hemodialysis Start]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Maria Carolina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fonseca]]></surname>
<given-names><![CDATA[José Agapito]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Bernardo Marques da]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Costa]]></surname>
<given-names><![CDATA[Claudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Branco]]></surname>
<given-names><![CDATA[Carolina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Outerelo]]></surname>
<given-names><![CDATA[Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Resina]]></surname>
<given-names><![CDATA[Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lopes]]></surname>
<given-names><![CDATA[José António]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gameiro]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidade de Lisboa Faculdade de Medicina ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Hospitalar Lisboa Norte Department of Medicine Division of Nephrology and Renal Transplantation]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>3-4</numero>
<fpage>56</fpage>
<lpage>62</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2976-05262024000300056&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2976-05262024000300056&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2976-05262024000300056&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Vascular access (VA) has a significant impact in the quality of life and survival of patients on hemodialysis (HD). The very elderly are a subgroup of patients whose incidence of renal replacement therapy is the highest. This study aimed to evaluate the impact of the VA at HD start on one&#8209;year mortality in this population.  Methods: Retrospective analysis of patients aged 80 years or older who started HD between January 2014 and December 2019 at Centro Hospitalar Universitário Lisboa Norte. We excluded patients who died in the first 90 days after dialysis started. Mortality within one year of HD start was evaluated. Demographic, clinical and laboratory variables were submitted to univariate and multivariate analysis to determine predictive factors of one&#8209;year mortality after HD start. Overall survival was analyzed using Kaplan&#8209;Meier curves and the log&#8209;rank test.  Results: One hundred eighty&#8209;nine patients were eligible. The mean age was 84.6 ± 3.59 years, and the majority were male (60.3%) and Caucasian (95.2%). One hundred and twenty&#8209;four patients started HD with a central venous catheter (CVC) (65.6%), 62 (32.8%) with an AVF and three patients (1.6%) with an AVG. Mortality within one year after HD started was 21.7% (n=41). One&#8209;year mortality was the highest in patients who started and remained with a CVC, compared to patients who started with a CVC and had an AVG placed, to patients who started with a CVC and had an AVF placed, to patients who started with an AVF and to patients who started with an AVG, respectively 43.2% vs 27.3% vs 21.7% vs 6.4% vs 0% (p&lt;0.001). On the multivariate analysis, only diabetes (aHR 2.49 (1.16&#8209;5.34), p=0.020) and starting and remaining with a CVC (aHR 3.83 (1.71&#8209;8.38), p=0.001) were significant predictors of one&#8209;year mortality.  Conclusion: In the very elderly, starting HD with a CVC and remaining with this VA is associated with higher mortality rather than starting with or switching to arteriovenous access.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Aged, 80 and over]]></kwd>
<kwd lng="en"><![CDATA[Arteriovenous Fistula]]></kwd>
<kwd lng="en"><![CDATA[Catheterization, Central Venous]]></kwd>
<kwd lng="en"><![CDATA[Kidney Failure, Chronic/therapy]]></kwd>
<kwd lng="en"><![CDATA[Renal Dialysis]]></kwd>
<kwd lng="en"><![CDATA[Vascular Access Devices]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<collab>KDIGO CKD Work Group</collab>
<article-title xml:lang=""><![CDATA[KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease]]></article-title>
<source><![CDATA[Kidney Int Suppl]]></source>
<year>2013</year>
<volume>3</volume>
<page-range>1-150</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coresh]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Selvin]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Stevens]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[Manzi]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Kusek]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Eggers]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of Chronic Kidney Disease in the United States]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2007</year>
<volume>298</volume>
<page-range>2038-47</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Murphy]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[McCulloch]]></surname>
<given-names><![CDATA[CE]]></given-names>
</name>
<name>
<surname><![CDATA[Lin]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Banerjee]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Bragg-Gresham]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Eberhardt]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Morgenstern]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Pavkov]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Saran]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Powe]]></surname>
<given-names><![CDATA[NR]]></given-names>
</name>
<name>
<surname><![CDATA[Hsu]]></surname>
<given-names><![CDATA[CY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Trends in Prevalence of Chronic Kidney Disease in the United States]]></article-title>
<collab>Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team</collab>
<source><![CDATA[Ann Intern Med]]></source>
<year>2016</year>
<volume>16</volume>
<page-range>473-81</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mallappallil]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Friedman]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Delano]]></surname>
<given-names><![CDATA[BG]]></given-names>
</name>
<name>
<surname><![CDATA[McFarlane]]></surname>
<given-names><![CDATA[SI]]></given-names>
</name>
<name>
<surname><![CDATA[Salifu]]></surname>
<given-names><![CDATA[MO]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Chronic kidney disease in the elderly evaluation and management]]></article-title>
<source><![CDATA[Clin Pract]]></source>
<year>2014</year>
<volume>11</volume>
<page-range>525-35</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saran]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Robinson]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Abbott]]></surname>
<given-names><![CDATA[KC]]></given-names>
</name>
<name>
<surname><![CDATA[Bragg-Gresham]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Gipson]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[US Renal Data System 2019 Annual Data Report Epidemiology of Kidney Disease in the United States]]></article-title>
<source><![CDATA[Am J Kidney Dis]]></source>
<year>2020</year>
<volume>75</volume>
<page-range>A6-7</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Goodkin]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Bragg-Gresham]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Koenig]]></surname>
<given-names><![CDATA[KG]]></given-names>
</name>
<name>
<surname><![CDATA[Wolfe]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Akiba]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Andreucci]]></surname>
<given-names><![CDATA[VE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States The Dialysis Outcomes and Practice Patterns Study (DOPPS)]]></article-title>
<source><![CDATA[J Am Soc Nephrol]]></source>
<year>2003</year>
<volume>14</volume>
<page-range>3270-7</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
