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[Vascular access outcome in patients aged over 75 years]
R López-Menchero1, C del Pozo, L Andreo
1Sección de Nefrología, Hospital Virgen de los Lirios de Alvoy, Polígono de Caramanchel s/n, 03804 Alvoy, Alicante. lopezmanchero_ram@gva.es
Insights
Elderly hemodialysis patients show similar vascular access outcomes to younger patients when using thorough pre-operative assessments. This suggests that increased use of grafts or catheters in older adults is unnecessary.
Area of Science:
- Nephrology
- Vascular Surgery
- Geriatrics
Background:
- Vascular access is crucial for hemodialysis.
- Optimal access choice in elderly patients remains debated.
- Age-related changes may impact access longevity.
Purpose of the Study:
- To compare hemodialysis vascular access outcomes in elderly (>=75 years) versus younger (<75 years) patients.
- To evaluate the influence of age on fistula, graft, and catheter performance.
- To determine if increased use of grafts or catheters is justified in elderly hemodialysis patients.
Main Methods:
- Retrospective study of 144 hemodialysis patients over 30 months.
- Analysis of 132 native fistulas, 12 grafts, and 27 tunneled catheters.
- Comparison of outcomes based on age groups, gender, diabetes, and fistula type.
Main Results:
- No significant differences in graft or catheter use between age groups.
- Similar primary failure rates for native fistulas (7.1% vs. 25.5% in elderly vs. younger).
- Comparable thrombosis rates and procedures for maintaining patency; diabetes negatively impacted patency.
Conclusions:
- Elderly hemodialysis patients exhibit similar vascular access evolution to younger patients with appropriate pre-operative assessment.
- Ecodoppler and consideration of proximal fistulas are key for successful access in the elderly.
- Routine use of grafts or catheters in elderly patients is not supported by these findings.
Unlabelled:
We report a retrospective study on the results of 132 native fistulas, 12 grafts and 27 tunneled catheters followed during 30 months in 144 patients on hemodialysis. The results were compared according to patient age: 75 years or over (n = 58, 80.3 +/- 3.5) vs below 75 years (n = 86, 59.5 +/- 13.3). Gender, presence of diabetes and type of fistula were also included in the analysis.
Results:
There were no statistically significant differences between both groups in the use of tunneled catheters or grafts (8.6% vs 5.8% y 5.2% vs 10.5% respectively), primary failure of native fistulas (7.1% in those aged 75 years or over vs 25.5% in patients below 75 years), rate of thrombosis (0.03 vs 0.09/patient year at risk respectively) or number of percutaneous or surgical procedures in order to maintain the fistula patency (0.11 vs 0.16/patient year at risk respectively). At the same time no differences were seen in the primary, primary assisted and secondary patency of the native fistulas. The mean age of the patients when the first access fistula was created was different according to the area of surgery (74.9 +/- 9.3 for the elbow vs 64.9 +/- 16.2 years for the forearm, p < 0.005). Diabetes was an unfavourable factor for primary (HR Cox 2.08, p < 0.05) or secondary (Log Rank, p <0.05) patency.
Conclusion:
The vascular access for hemodialysis in elderly patients presents a similar evolution to that seen in younger populations if the access creation is based on an exhaustive study, including ecodoppler of the vascular map and the use of more proximal fistulas if necessary. Therefore the more frequent use of grafts or catheters in elderly patients is not justified.
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