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Vascular access in super-aged patients.
Hideki Kawanishi1,2, Sadanori Shintaku1, Misaki Moriishi1
1Tsuchiya General Hospital, Hiroshima - Japan.
The Journal of Vascular Access
|September 10, 2015
Summary
Elderly patients initiating dialysis with a temporary central venous catheter (CVC) face higher mortality risk. Arteriovenous fistula (AVF) offers comparable survival for younger patients, but CVC is often an emergency measure for the elderly.
Area of Science:
- Nephrology
- Geriatric Medicine
- Vascular Access
Background:
- Dialysis patient populations are aging globally.
- Clinical practice guidelines lack specific recommendations for vascular access (VA) in elderly patients.
- VA choice is critical for prognosis in older adults undergoing renal replacement therapy (RRT).
Purpose of the Study:
- To investigate the relationship between vascular access type at dialysis initiation and prognosis in elderly patients.
- To identify the optimal vascular access type for elderly dialysis patients.
- To analyze survival outcomes based on VA choice in different age groups.
Main Methods:
- Retrospective observational cohort study.
- Included adult patients (≥18 years) initiating RRT between 2003-2010.
- Vascular access types analyzed: arteriovenous fistula (AVF) and temporary central venous catheter (CVC).
Main Results:
- Elderly patients (≥70 years) initiating dialysis with CVC had significantly lower survival rates compared to AVF.
- Survival rates were comparable between nonelderly patients (<70 years) using CVC or AVF.
- In super-aged (≥80 years) and aged (70-79 years) patients, CVC initiation correlated with poorer survival than AVF.
Conclusions:
- Initiating dialysis with CVC is not a mortality risk factor for nonelderly patients.
- For elderly (≥70 years) and super-aged (≥80 years) patients, CVC initiation increases mortality risk.
- Elderly patients often require CVC due to emergency clinical conditions like inflammation.
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