Arteriovenous fistula outcomes in the elderly

McGrogan, Damian; Shakarchi, Julien Al; Khawaja, Aurangzaib; Nath, Jay; Hodson, James; Maxwell, Alexander P.; Inston, Nicholas

doi:10.1016/j.jvs.2015.07.067

Cited by 39 publications

(40 citation statements)

References 26 publications

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“…In comparison with previous studies (Lok) and metaanalyses (McGrogan), primary and secondary patency rates were lower the first year versus the second year (36.7% versus 53.6%, 56.8% versus 71.6%) [21,28]. Rates of failure to mature were higher in the first year as well, at 61.8% versus 49% [21].…”

Section: Vascular Accesscontrasting

confidence: 56%

Untitled

2017

Cent Asian J Med Sci

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The inevitable reality of today is that the world population is aging, and the elderly (above 65 years) are more prevalent among the dialysis population worldwide. Objectives: The purpose of this review is to do a literature search on issues related to dialysis in the elderly Asian population, such as vascular access outcomes, complication rates, and survival data by modality on hemodialysis (HD) and peritoneal dialysis (PD). Methods: A literature search on key topic areas was done on articles published in English between January 1, 2005 and December 31, 2015. Results: Although incidences of elderly dialysis patients are increasing in Asia, we found that large-scale data is lacking. Further research is needed to assess dialysis outcomes among the elderly. Available studies suggest acceptable outcomes in vascular access, primary and secondary patency rates, and similar intervention rates compared to non-elderly. Survival data suggests superior outcomes in HD in elderly. Due to significant differences in dialysis practices in Asia, a proper comparison is difficult. Conclusion: Age alone is not a contraindication for dialysis.

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Section: Vascular Accesscontrasting

confidence: 56%

Untitled

2017

Cent Asian J Med Sci

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“…Over 90% of the endoAVFs in NEAT reached physiologic maturation and 67% of endoAVFs were routinely used for dialysis with 2-needle cannulation. The endoAVF usability of 67% compares with the 40%-70% rates reported in the surgical AVF literature (9,20). The lower rate of procedures to facilitate maturation, such as the use of angioplasty, stenting, and thrombectomy, reflected the low complication and early thrombosis rate seen in NEAT and the high physiologic endoAVF maturation observed (11).…”

Section: Discussionmentioning

confidence: 93%

Comparison of Post-Creation Procedures and Costs between Surgical and an Endovascular Approach to Arteriovenous Fistula Creation

Yang¹,

Lok

Arnold

et al. 2017

J Vasc Access

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additional procedures to facilitate maturation and maintain function after the initial AVF creation (3, 4). Despite these procedures, a substantial proportion of AVFs never become usable for hemodialysis, leaving the patient dependent on temporary central venous catheters (CVCs) for an extended time before another arteriovenous access (prosthetic arteriovenous graft [AVG]) or a new surgical AVF [SAVF]) can be created and used (5, 6). Such catheter dependence can lead to complications, such as infection. Importantly, AVFs that require facilitative procedures for maturation have poorer durability than those that do not (7, 8). A new endovascular catheter-based system the everlinQ endoAVF System, has been developed that uses a minimally invasive method to create an AVF (endoAVF) as an alternative to the traditional open surgical approach (9, 10). The everlinQ endoAVF system creates a side-to-side anastomosis without open surgery or vessel dissection, minimizing trauma to the vessels. A prospective clinical study, the Novel Endovascular

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“…18 However, other studies have suggested that age does not have an important impact on fistula outcomes. 19-22 In a retrospective study of 658 patients referred for fistula creation, Weale et al 22 assessed the impact of age on functional outcomes and found no difference in primary or secondary patency with radiocephalic and brachiocephalic fistulas in patients less than 65 years of age, 65 to 69 years of age, and those 80 years of age and older. Inconsistency in prior studies may relate to sample size considerations, a preponderance of single-center studies, differences in definitions, and the lack of adequate risk adjustment for other important predictors of fistula outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Age on the Likelihood of Catheter-Free Fistula Use in Hemodialysis Patients

Ladak

Ravani

Oliver

et al. 2019

Can J Kidney Health Dis

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Background: Clinical practice guidelines recommend arteriovenous fistulas as the preferred form of vascular access for hemodialysis. However, some studies have suggested that older age is associated with poorer fistula outcomes. Objective: We assessed the impact of age on the outcomes of fistula creation and access-related procedures. Design: This was a prospective cohort study using data collected as part of the Dialysis Measurement Analysis and Reporting (DMAR) system. Setting: Participating Canadian dialysis programs, including Southern Alberta Renal Program, Manitoba Renal Program, Sunnybrook Health Sciences Centre (Toronto, Ontario), London Health Sciences Centre (London, Ontario), and The Ottawa Hospital (Ottawa, Ontario). Patients: Incident hemodialysis patients aged 18 years and older who started dialysis between January 1, 2004, and May 31, 2012. Measurements: The primary outcome was the proportion of all first fistula attempts that resulted in catheter-free fistula use, defined as independent use of a fistula for hemodialysis (ie, no catheter in place). Secondary outcomes included the time to catheter-free fistula use among patients with a fistula creation attempt, total number of days of catheter-free fistula use, and the proportion of a patient’s hemodialysis career spent with an independently functioning fistula (ie, catheter-free fistula use). Methods: We compared patient characteristics by age group, using t tests or Wilcoxon rank sum tests, and chi-square or Fisher exact tests, as appropriate. Logistic and fractional logistic regression were used to estimate the odds of achieving catheter-free fistula use by age group and the proportion of dialysis time spent catheter-free, respectively. Results: A total of 1091 patients met our inclusion criteria (567 age ≥ 65; 524 age < 65). Only 57% of first fistula attempts resulted in catheter-free fistula use irrespective of age (adjusted odds ratio [OR]≥65vs<65: 1.01; P = .93). The median time from hemodialysis start to catheter-free use of the first fistula did not differ by age when grouped into fistulas attempted pre- and post-dialysis initiation. The adjusted rates of access-related procedures were comparable (incidence rate ratio [IRR]≥65vs<65: 0.95; P = .32). The median percentage of follow-up time spent catheter-free was similar and low in patients who attempted fistulas (<65 years: 19% vs ≥65 years: 21%; P = .85). Limitations: The relatively short follow-up time may have underestimated the benefits of fistula creation and the observational study design precludes inferences about causality. Conclusions: In our study, older patients who underwent a fistula attempt were just as likely as younger patients to achieve catheter-free fistula use, within a similar time frame, and while requiring a similar number of access procedures. However, the minority of dialysis time was spent catheter-free.

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Arteriovenous fistula outcomes in the elderly

Cited by 39 publications

References 26 publications

Untitled

Untitled

Comparison of Post-Creation Procedures and Costs between Surgical and an Endovascular Approach to Arteriovenous Fistula Creation

The Influence of Age on the Likelihood of Catheter-Free Fistula Use in Hemodialysis Patients

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