[Vascular access outcome in patients aged over 75 years]

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.