Impact of Prepared Vascular Access on Mortality and Medical Expenses in Elderly and Nonelderly Japanese Patients with CKD Stage G5: A Retrospective Cohort Study

Background: Patients with chronic kidney disease (CKD) stage 5 (CKDG5) have greater dialysis requirements that increase the risk of cardiovascular disease and mortality. The elevated costs associated with CKDG5 are a serious concern. The impact of prepared vascular access (VA) through planned VA creation on mortality and medical expenses remains unclear in Japanese patients with CKDG5. Methods: We conducted a retrospective cohort study of 157 patients with CKD who started hemodialysis (HD) at Shinshu University Hospital from April 2016 to March 2021 and analyzed the relationship between the presence of a prepared VA and mortality and hospitalization expenses in elderly and non-elderly patients with CKDG5. Results: The presence of a prepared VA was associated with lower mortality in non-elderly patients but not in elderly patients. Medical expenses, emergency HD, and hospitalization duration were significantly lower in patients with a prepared VA in both age groups. The contribution of a prepared VA to mortality and medical expenses remained consistent after adjusting for sex, performance status, comorbidities, and nutritional status. Conclusion: A prepared VA has several benefits; however, the prognostic benefit was not observed in elderly patients with CKDG5. From a prognostic perspective, we should consider patient’s general condition and predicted prognosis in proactive decision-making regarding the selection of renal replacement therapy and VA preparation in elderly patients.