Vascular Access in the Elderly: Does One Size Fit All?

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

Download Full-text

Vascular Access for Dialysis in the Elderly

Blood Purification ◽

10.1159/000066961 ◽

2002 ◽

Vol 20 (6) ◽

pp. 563-568 ◽

Cited By ~ 15

Author(s):

Natalia Ridao-Cano ◽

José R. Polo ◽

Jorge Polo ◽

Rafael Pérez-García ◽

Mercedes Sanchez ◽

...

Keyword(s):

Vascular Access ◽

The Elderly

Download Full-text

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

American Journal of Nephrology ◽

10.1159/000444889 ◽

2016 ◽

Vol 43 (2) ◽

pp. 120-128 ◽

Cited By ~ 11

Author(s):

Hoon Suk Park ◽

Woo Jeong Kim ◽

Yong Kyun Kim ◽

Hyung Wook Kim ◽

Bum Soon Choi ◽

...

Keyword(s):

Life Expectancy ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Prospective Cohort ◽

Survival Benefit ◽

Patient Survival ◽

The Elderly ◽

Arteriovenous Graft ◽

Poor Patient ◽

Poor Patient Survival

Background: Poor vessel quality and limited life expectancy in the elderly may make arteriovenous fistula (AVF) less ideal than arteriovenous graft (AVG) or catheter for vascular access (VA) in hemodialysis (HD). Methods: A total of 946 adult incident HD patients from clinical research center registry for end-stage renal disease prospective cohort in South Korea were analyzed for outcomes with AVF and AVG. Results: Overall, AVF was associated with better patient survival only in male (p < 0.001) and diabetic (p = 0.004) patients, although it was superior to AVG in access patency, regardless of diabetes mellitus status and gender. AVG (vs. AVF; hazard ratio (HR) 2.282; 95% CI 1.071-4.861; p = 0.032) was associated with poor patient survival. In elderly patients (≥65 years), AVF was associated with survival benefit only in male (p < 0.001) and diabetic (p = 0.04) patients, and with better access patency only in female (p = 0.05) and diabetic (p = 0.04) patients. AVG (vs. AVF; HR 3.158; 95% CI 1.080-9.238; p = 0.036) was associated with poor patient survival. In septuagenarian patients, AVF was associated only with survival benefit (p = 0.01) and there was no advantage in access patency (p = 0.12). However, AVF was superior to AVG in both access patency (p = 0.001) and patient survival (p = 0.03) even with propensity matching. Conclusion: AVF is the more desirable VA and its survival benefits warrant its consideration in septuagenarian patients although a prolonged life expectancy is essential to realize the potential benefits of AVF.

Download Full-text

P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1339 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vinant Bhargava ◽

Priti Meena ◽

Ambrish Satwik ◽

Apurv Srivastava ◽

A K Bhalla ◽

...

Keyword(s):

Elderly Patients ◽

Vascular Access ◽

Elderly Population ◽

The Elderly ◽

Primary Patency ◽

New Delhi ◽

Secondary Patency ◽

Basilic Vein ◽

The Mean

Abstract Background and Aims With the increase in the line expectancy of chronic kidney disease in the older population (>60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (>60 years). Method Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates. Results A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF. Conclusion AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.

Download Full-text

Optimizing Vascular Access in the Elderly: Words we Use Affect Patient Care

The Journal of Vascular Access ◽

10.5301/jva.5000466 ◽

2015 ◽

Vol 16 (6) ◽

pp. 437-438 ◽

Cited By ~ 2

Author(s):

Ingemar Davidson ◽

Maurizio Gallieni

Keyword(s):

Patient Care ◽

Vascular Access ◽

The Elderly ◽

Affect Patient Care

Download Full-text

Optimal Hemodialysis Vascular Access in the Elderly Patient

Seminars in Dialysis ◽

10.1111/sdi.12037 ◽

2012 ◽

Vol 25 (6) ◽

pp. 640-648 ◽

Cited By ~ 53

Author(s):

Louise M. Moist ◽

Charmaine E. Lok ◽

Tushar J. Vachharajani ◽

Wang Xi ◽

Ahmed AlJaishi ◽

...

Keyword(s):

Elderly Patient ◽

Vascular Access ◽

The Elderly ◽

Hemodialysis Vascular Access

Download Full-text

The Effect of Age on Radiocephalic Fistula Patency

The Journal of Vascular Access ◽

10.1177/112972980100200305 ◽

2001 ◽

Vol 2 (3) ◽

pp. 110-113 ◽

Cited By ~ 15

Author(s):

C.G. Burt ◽

J.A. Little ◽

D.A. Mosquera

Keyword(s):

Vascular Access ◽

The Elderly ◽

Older Age ◽

Fistula Formation ◽

Age Group ◽

Vascular Surgeon ◽

Age Over 60 ◽

Surgical Unit ◽

Effect Of Age

Background Inferior patency rates for radiocephalic fistulae in the elderly have been reported and may explain the increasing use of prosthetic grafts for vascular access. The aim of this study was to assess whether the patency rates of primary radiocephalic fistulae are affected by age. Methods A retrospective casenote review of 53 consecutive patients undergoing primary fistula formation between 1995 and 1998 under the care of a single consultant vascular surgeon. The setting was a specialist vascular surgical unit where the protocol is to offer all new patients a radiocephalic fistula. Fistula patency was defined as successful use for dialysis. Results Cumulative patency rates at 2 years were 60% in patients over 60 years (n=27), and 53% in patients under 60 years (n=26). The higher patency rates in the older age group were not significant on log rank testing (p=0.39). Conclusion Age over 60 years did not influence patency rates of primary radiocephalic fistulae, which should remain the haemodialysis access procedure of choice at all ages.

Download Full-text