[Updates in clinical hemodialysis: vascular accessess and elderly patients]

SUMMARY In most current hemodialysis (HD) units, two of the most significant problems are vascular access and the steady increase in incident elderly patients. Both are risk factors for morbidity and mortality that require frequent hospitalizations and have a very considerable health cost. The aim of this review is to show the most interesting studies published in 2007 on these two aspects. Regarding vascular access for hemodialysis, a very worrying fact is the progressive increase in incident and prevalent patients dialyzed with a permanent catheter, even though the catheter is a known risk factor of great morbidity and mortality. The dialysis units should have as their goals to reduce the percentage of catheters and to detect early arteriovenous fistulas at risk of thrombosis. In recent years, the incidence of patients of very advanced age is experiencing a notable increase. This type of patients has a high rate of morbidity and mortality. The great challenge for nephrologists is know which patients can really benefit from dialysis treatment. Furthermore, this type of patients have different characteristics than the rest of the general dialysis population, which makes it necessary to adopt different clinical criteria.