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Geriatric hemodialysis patients: a comparative study of vascular access
Insights
Elderly hemodialysis patients more frequently receive polytetrafluoroethylene (PTFE) grafts, increasing their risk of vascular access thrombosis (VAT). Oral anticoagulants did not significantly reduce VAT risk in this older group, unlike in younger patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Geriatrics
Background:
- Vascular access is crucial for hemodialysis patients.
- Age-related differences in vascular access complications are not well understood.
- Comorbidities like peripheral vascular disease (PVD) are more prevalent in older adults.
Purpose of the Study:
- To compare vascular access types and outcomes in hemodialysis patients aged 65 and older versus those younger than 65.
- To analyze the influence of comorbid diseases on vascular access in different age groups.
- To evaluate the risk of vascular access thrombosis (VAT) between age cohorts.
Main Methods:
- A descriptive, longitudinal study with 1-year follow-up.
- 267 hemodialysis patients were sampled across four states, stratified by age (<65 and >=65 years).
- Data collected included access type, comorbid conditions, and VAT events; odds ratios (OR) were calculated.
Main Results:
- Patients >= 65 years had a higher frequency of polytetrafluoroethylene (PTFE) grafts and higher prevalence of PVD.
- PTFE grafts were associated with a significantly higher risk of VAT in patients >= 65 years (OR 3.38).
- Oral anticoagulants reduced VAT risk in patients < 65 years but not in the older group.
Conclusions:
- Geriatric hemodialysis patients are more likely to use PTFE grafts, potentially due to higher PVD prevalence.
- PTFE grafts in elderly patients are linked to increased VAT risk compared to arteriovenous fistulas (AVFs).
- The ineffectiveness of oral anticoagulants in reducing VAT in older patients may be related to higher PTFE graft usage.
Objectives:
To compare vascular access in hemodialysis patients > or = 65 years of age with those < 65 years on the following: 1) comorbid disease status, 2) types of vascular access used, and 3) outcome.
Sample/Setting:
Hemodialysis patients in a four-state region (Iowa, Kansas, Nebraska, and Missouri) from both free-standing and hospital-affiliated providers were sampled (n = 267). A stratified sampling strategy was used in order to obtain approximately equal-sized age groups (< 65 years and > or = 65 years).
Design:
A descriptive, longitudinal study with a 1-year follow-up period.
Methods:
Following the placement of a permanent vascular access, information was collected by the dialysis nursing staff about the configuration of the access, needle gauge used for cannulation, dialysis prescriptions, diabetic status, and other comorbid disease conditions. Odds ratios (OR) for vascular access thrombosis (VAT) risk were calculated between the two age groups.
Results:
Comparisons between the two age groups suggest a higher frequency of polytetrafluorethylene (PTFE) grafts in the > or = 65-year-old age group. Peripheral vascular disease (PVD) prevalence was also higher in elders. Oral anticoagulants reduced the risk of VAT in those < 65-year-old group. Patients age > or = 65 years with a PTFE graft experienced a higher risk of VAT (OR 3.38, 95% confidence interval 1.43, 8.11) than those in the same age group with an arteriovenous fistula (AVF).
Conclusions:
PTFE grafts are used more frequently among geriatric hemodialysis patients, possibly due to the increased prevalence of peripheral vascular disease (PVD). While use of oral anticoagulants is effective in reducing the risk of VAT among those < 65 years, it did not significantly reduce VAT risk in geriatric hemodialysis patients. This observation may be due to the higher frequencies of PTFE grafts in elderly patients.