# Impact of prepared vascular access on mortality and medical expenses in elderly and non-elderly Japanese patients with chronic kidney disease stage G5: a retrospective cohort study

## TL;DR

This study shows that planned vascular access creation in Japanese patients with advanced kidney disease reduces hospital costs and mortality, especially in younger patients.

## Contribution

The study demonstrates that prepared vascular access reduces mortality and medical expenses in Japanese CKD stage G5 patients, with distinct effects in elderly and non-elderly groups.

## Key findings

- Prepared vascular access was associated with lower mortality in non-elderly CKDG5 patients.
- Medical expenses and hospitalization duration were significantly lower with prepared vascular access.
- Planned vascular access creation reduced hospitalization expenses regardless of patient age.

## Abstract

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.

We conducted a retrospective cohort study including 157 patients with CKD who started hemodialysis (HD) at Shinshu University Hospital from April 2016 to March 2021 and assessed the relationship between the presence of a prepared VA and mortality and hospitalization expenses in elderly and non-elderly patients with CKDG5.

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.

A prepared VA showed several benefits, including lower mortality rates and hospitalization costs; shorter hospital stays; and higher home discharge rates. Planned VA creation was significantly associated with lower hospitalization expenses, irrespective of age.

The online version contains supplementary material available at 10.1007/s10157-025-02654-3.