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Vascular access for hemodialysis in the elderly
Nicola Swindlehurst1, Andrew Swindlehurst, Heather Lumgair
1Department of Transplant Surgery, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom. nicola.swindlehurst@doctors.org.uk
Journal of Vascular Surgery
|January 11, 2011
Summary
Vascular access creation for hemodialysis in elderly patients (≥65 years) shows comparable outcomes to younger patients (<65 years). Arteriovenous fistulas in the elderly demonstrate high patency rates and shorter hospital stays, making them a viable option.
Area of Science:
- Vascular Surgery
- Nephrology
- Geriatric Medicine
Background:
- Increasing prevalence of elderly patients requiring hemodialysis.
- Challenges in creating effective vascular access for hemodialysis in older adults.
- Need to evaluate outcomes of hemodialysis access in elderly populations.
Purpose of the Study:
- To analyze the outcomes of conduit creation for hemodialysis in elderly patients (≥65 years).
- To compare the outcomes of vascular access in elderly patients with a younger cohort (<65 years).
Main Methods:
- Retrospective analysis of prospectively collected data from January 1, 2000, to December 31, 2006.
- Inclusion of first-time arteriovenous fistula (AVF) and graft creations.
- Comparison between elderly (Group A, ≥65 years) and non-elderly (Group B, <65 years) patients.
Main Results:
- No significant differences in primary patency (70% vs 68%), assisted primary patency (73% vs 77%), or secondary patency (73% vs 79%) between groups.
- Higher incidence of failure to mature in the elderly group (6.1% vs 1.1%, P = .03).
- Similar rates of death with functioning conduit (56% vs 54%) and mean conduit survival.
- Lower rate of salvage procedures in the elderly group (2.5% vs 10.1%).
- Shorter mean hospital stay for elderly patients (3.2 days).
Conclusions:
- Creation of permanent hemodialysis access, particularly arteriovenous fistulas, is feasible and effective in elderly patients.
- Elderly patients experience high patency rates and acceptable intervention rates for hemodialysis access.
- Short hospital stays are associated with hemodialysis access creation in the elderly.
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