Which vascular access for chronic hemodialysis in uremic elderly patients?

Area of Science:

• Nephrology
• Vascular Surgery
• Geriatrics

Background:

• Vascular access type significantly impacts hemodialysis outcomes and patient morbidity.
• Complications like thrombosis and infection are more common with grafts and catheters compared to native fistulas.
• Elderly patients often have compromised vascular beds, potentially complicating fistula creation.

Purpose of the Study:

• To compare the feasibility and outcomes of different hemodialysis vascular access types in elderly versus younger patients.
• To evaluate the incidence of complications and the need for secondary access in different age groups.
• To determine if native fistulas can be effectively created in the majority of elderly patients.

Main Methods:

• Retrospective analysis of 140 elderly (>65 years) and 63 younger (<65 years) patients over a 5-year period.
• Documenting the primary type of vascular access created (fistula, graft, catheter).
• Tracking access survival rates, thrombosis incidence, and the need for alternative access types.

Main Results:

• Native fistulas were created in 88% of elderly patients and 94% of younger patients (p: NS).
• Grafts were used in 11% of elderly and 6% of younger patients.
• Permanent catheters were rarely used as the primary access, even in the elderly.

Conclusions:

• Native fistulas are a viable and primary option for hemodialysis vascular access in elderly patients.
• Graft and catheter use should be minimized and reserved for specific cases in all age groups.
• Optimizing native fistula creation in elderly patients can reduce access-related complications and improve dialysis treatment.