Optimal timing of arteriovenous fistula placement in elderly patients

Introduction: To investigate optimal timing of cessation and resumption of anti-thrombotic therapy (ATT) during gastrointestinal endoscopy in Chinese elderly patients. Methods: Between January 1st 2008 and December 31st 2014,at Chinese PLA General Hospital, 3747 patients (76.03±10.3 years) hospitalized for elective gastrointestinal endoscopy were retrospectively analyzed. The study population were predominately male(96.1%) and senile(age ≥60, 92.3%).Patients‘ peri-endoscopic management of ATT and adverse events (thromboembolism and bleeding) were recorded. RхC tables were used to compare the differences of peri-endoscopic adverse events among patients with different peri-endoscopic management of ATT. Results: the peri-endoscopic thromboembolic incidence in those with discontinuing ATT ≥7 days before procedure was significantly higher (8.12%). No difference of bleeding incidence was found among different cessation time before procedure. The peri-endoscopic thromboembolic incidence increased as the delaying of resuming ATT after procedure. However, the incidence of peri-endoscopic bleeding in patients with resuming ATT 2-7 days after procedure was lowest (0.63%). The reason why bleeding incidences in patients with resuming ATT >7 days, and those without resuming ATT were much higher than those with resuming ATT 2-7 days was that occurrence of bleeding urged physician to postpone or cancel resumption of ATT. When discontinuing ATT, the differences of peri-endoscopic thromboembolic or bleeding events between patients receiving low-molecular-weight heparin bridging therapy and those without bridging therapy were not significant. Conclusions: Cessation of ATT <7 days before endoscopic procedure and resumption of ATT in 2-7days after procedure were optimal peri-endoscopic ATT management strategy for Chinese elderly patients.Bridging therapy couldn’t protect elderly patients from peri-endoscopic thromboembolic events.

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MO776THE USE OF HAND GRIP DEVICE IN ELDERLY PATIENTS ON ARTERIOVENOUS FISTULA MATURATION PROCESS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab103.0014 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Irati Tapia González ◽

Vicent Esteve ◽

Sara Ibañez ◽

Sandra Rubio ◽

Fatima Moreno Guzman ◽

...

Keyword(s):

Elderly Patients ◽

Training Program ◽

Arteriovenous Fistula ◽

Elderly Population ◽

Therapeutic Option ◽

Demographic Data ◽

Blood Flow Rate ◽

Control Group ◽

Maturation Process ◽

Hand Grip

Abstract Introduction The indication of creation arteriovenous fistula(AVF) may be controversial in elderly population with advanced chronic kidney disease (CKD). Postoperative exercises improve maturation. However, sometimes these exercises could be difficult to perform in the elderly CKD patients. The hand grip device is easy to use, inexpensive and able to increase the muscles of the hand and foream. Nevertheless, scarce scientific evidence has been reported about the role of hand grip device on AVF maturation process in elderly population. Objectives To evaluate the efficacy of a hand grip training program on AVF maturation in our patients older than 75 years old with stages 5-5D CKD. Methodology A 15 months prospective study. After surgery, all patients were randomized to hand grip group (HG) or control group (CG). HG performed a training program using a hand grip device. CO received usual care. Demographics data, upper limb muscle strength (ULMS), Doppler ultrasound (DUS), measurements (outflow vein (OV) diameter and humeral artery blood flow rate (BFR), DUS and clinical AVF maturation as well as VA related complications (hematoma, stenosis, thrombosis, pseudoaneurysm, aneurysm) were assessed at 4 and 8 weeks postoperatively. Results 29 patients. 16 HG, 13 CO. 69% men. Mean age 80,5±2,9 years. 41,4% Radiocephalic AVF. Demographic data, ULMS and DUS measurement at baseline were similar. A significant increase was observed in ULMS only in HG at the end of study (18,8±6,5 vs 21,3±7,1Kg, p=0,005). DUS measurements statistically increased for both groups (OV diameter: CG 2,9 ± 0,6 vs. 5,8 ± 1,4mm; HG 2,9 ± 0,8 vs. 7,2 ± 2,2 mm; humeral artery BFR: CG 132,9± 30,3 vs. 1310,2 ± 691,8ml/min; HG 128,1± 28,9 vs. 1530,7 ± 708,9 ml/min) at the end of study. HG group obtained highest clinical (CG 21,4% vs HG 78,6%;p=0,018) and DUS maturation (CG 27,8% vs HG 72,2%; p=0,011) at 4 weeks and highest clinical (CG 20% vs HG 80%;p=0,007) and DUS maturation (CG 25% vs HG 75%; p=0,002) at 8 weeks, significantly. Despite no significant differences, the number of complications was lower in the HG, mainly significant stenosis (CG 60% vs HG 40%; p=0,428). Conclusions The hand grip device is a useful, safety and easy to use training device to improve the AVF maturation in elderly patients. This device results a novel therapeutic option for the AVF maturation in elderly patients. Further studies are required to support these outcomes in this population.

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