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Dialysis: 'catheter last' not 'fistula first' in elderly patients

Christian Combe1, Xavier Bérard

  • 1Service de Néphrologie Transplantation Dialyse, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, 33076 Bordeaux, France.

Nature Reviews. Nephrology
|September 4, 2013
PubMed

Insights

For elderly patients over 80 needing hemodialysis, arteriovenous fistulas may not be better than prosthetic grafts for vascular access. Avoiding catheters as the initial access is crucial to reduce mortality risks.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Geriatrics

Background:

  • Vascular access is critical for hemodialysis, especially in elderly patients.
  • Arteriovenous fistulas and prosthetic grafts are common options, each with potential benefits and risks.
  • Catheter use is associated with complications and increased mortality.

Purpose of the Study:

  • To compare the efficacy of arteriovenous fistulas versus prosthetic grafts as predialysis vascular access in patients aged 80 years and older.
  • To evaluate the impact of initial vascular access choice on mortality in this patient population.

Main Methods:

  • Retrospective analysis of patient data.
  • Comparison of outcomes between patients receiving arteriovenous fistulas and prosthetic grafts.
  • Assessment of mortality rates based on initial vascular access type (fistula, graft, or catheter).

Main Results:

  • Arteriovenous fistulas were not found to be superior to prosthetic grafts for predialysis vascular access in patients aged 80+.
  • Initial use of catheters for vascular access was linked to significantly higher mortality rates in this age group.

Conclusions:

  • The choice between arteriovenous fistulas and prosthetic grafts may not significantly impact outcomes for elderly hemodialysis patients.
  • Catheter use as the primary vascular access in patients aged 80 and older should be avoided due to increased mortality risk.

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