Abstract: Objective  To observe the clinical characteristics of elderly patients (≥60 years old) managed with maintenance hemodialysis (MHD) and to investigate the effect of vascular access type on survival of the patients.  Methods  Patients beginning hemodialysis in the period from January 1, 2017 to December 31, 2021 were recruited as the research subjects. They were followed up until June 31, 2022, and the endpoint was all-cause death in the follow-up period. According to vascular access type, patients were divided into 2 groups: autologous arteriovenous fistula group (AVF group) and tunneled cuffed catheter group (TCC group). Kaplan-Meier method was used to analyze the survival rate. Log-rank test was used to compare the survival rate. Cox regression model was performed to analyze the influencing factors.  Results  A total of 133 elderly MHD patients were included in this study, and 33 patients died. The top three death causes were cardiovascular events, multiple organ failure and malignant tumors. The primary diseases were diabetic nephropathy (45.11%) and chronic glomerulonephritis (44.36%). Among the 133 MHD patients, 72.93% used AVF (AVF group) and 27.07% used TCC (TCC) group as the vascular access. There were differences in age (Z=6.177, P＜0.001), Hb (Z=2.489, P=0.013), blood creatinine (t=2.687, P＜0.001), albumin (Z=2.093, P＜0.001), and hs-CRP (Z=4.872, P＜0.001) between the two groups. After 12, 24, 36 months, the survival rates in AVF group were 93.2%, 84.1% and 71.4% respectively, and the survival rates in TCC group were 74.5%, 53.0% and 37.6% respectively. Log-rank test demonstrated that the survival rate was lower in TCC group than in AVF group (χ2=22.665, P<0.001). Multivariate COX regression indicated that TCC was an independent risk factor for survival in elderly MHD patients (HR=0.420, 95% CI: 0.183～0.963, P=0.040).  Conclusions  In elderly MHD patients, the top there death causes are cardiovascular events, multiple organ failure and malignant tumors, and the main primary diseases are diabetes mellitus and chronic glomerulonephritis. Patients using TCC as the vascular access have a lower survival rate, and TCC for vascular access is an independent risk factor for survival in elderly MHD patients. 

Key words: Hemodialysis, Elderly patients, Survival, Catheter