Finding the right hemodialysis vascular access in the elderly: a patient-centered approach

Vascular access preparation in the elderly with advanced kidney disease needs a nuanced approach. Recent studies indicate that age, along with comorbidity, modify the outcomes associated with the type of access placed or used for hemodialysis (HD). Options ranging from permanent vascular access (arteriovenous fistula [AVF] or graft [AVG]) to tunneled central venous catheter (TCVC) or conservative medical care must be weighed on an individual basis and reassessed longitudinally. The potential benefits derived from AVF compared with AVG and TCVC are not always seen in this population. Herein, we review the literature concerning patient and vascular access outcomes in the elderly with advanced kidney disease or on HD. A multidimensional approach that takes into consideration the burden of comorbid diseases, functional status and patient-reported views on quality of life ought to be incorporated in the process of vascular access planning in the elderly.