[Vascular access in the elderly: AVF vs CVC. A comment]

Area of Science:

• Nephrology
• Vascular Surgery
• Geriatrics

Background:

• Aging population undergoing hemodialysis presents complex vascular access challenges.
• Center-specific practices and increasing use of permanent central venous catheters (CVCs) influence access selection.
• Evolving guidelines (e.g., K-DOQI) impact the timing and choice of vascular access.

Purpose of the Study:

• To determine the optimal vascular access strategy for elderly patients with multiple comorbidities requiring hemodialysis.
• To highlight the importance of a multidisciplinary approach in vascular access selection.
• To evaluate the role of patient-specific factors, including cardiovascular risk, in choosing between fistulas and CVCs.

Main Methods:

• Review of existing literature and clinical audit data (DOPPS, Lombardy).
• Analysis of trends in vascular access utilization, including native fistulas, prosthetic fistulas, and permanent CVCs.
• Emphasis on a global clinical evaluation of the patient.

Main Results:

• Native and prosthetic fistulas are generally superior to CVCs for hemodialysis.
• CVCs offer advantages in specific patient groups, such as those with severe cardiac conditions.
• A multidisciplinary team approach involving nephrologists, vascular surgeons, and interventional radiologists is crucial.

Conclusions:

• Individualized patient assessment, considering renal function and cardiovascular risk, is paramount for selecting the most appropriate vascular access.
• Centers capable of offering diverse access options (fistulas and CVCs) enable optimal nephrologist decision-making.
• The nephrologist plays a central role in managing vascular access within a collaborative team.