Vascular access for dialysis in the elderly

Area of Science:

• Nephrology
• Vascular Surgery
• Clinical Outcomes

Background:

• Vascular access is crucial for hemodialysis.
• Choosing the appropriate vascular access type impacts patient outcomes.
• Age can influence the choice and success of vascular access.

Purpose of the Study:

• To evaluate early and late outcomes of initial vascular accesses.
• To compare outcomes in patients younger and older than 65 years.
• To analyze complication rates and patency in different age groups.

Main Methods:

• Retrospective analysis of vascular accesses performed between 1992 and 1997.
• Inclusion criteria: patients without prior permanent angioaccess.
• Analysis of early failure, complication rates (per patient-year), and cumulative patency.

Main Results:

• Autologous fistulas demonstrated superior primary patency (p < 0.001) and lower complication rates (0.09/patient-year) compared to grafts (0.58/patient-year) across both age groups.
• Older patients (≥65 years) required a significantly higher proportion of grafts (34%) versus younger patients (25%) (p < 0.01).
• Complication rates were higher in older patients for both autologous fistulas (0.12 vs 0.07/patient-year) and grafts (0.8 vs 0.5/patient-year), though patency rates did not differ significantly by age.

Conclusions:

• Autologous vascular access is the preferred method for dialysis, even in elderly patients.
• Autologous access can be successfully created in the majority of patients needing initial dialysis access.
• Despite the benefits of autologous access, a greater need for synthetic grafts was observed in patients over 65 years old.