Dialysis Access as an Area of Improvement in Elderly Incident Hemodialysis Patients: Results from a Cohort Study from the International Monitoring Dialysis Outcomes Initiative

Abstract

Background: Commencing hemodialysis (HD) using a catheter is associated with a higher risk of adverse outcomes, and early conversion from central-venous catheter (CVC) to arteriovenous fistula/graft (non-CVC) improves outcomes. We investigated CVC prevalence and conversion, and their effects on outcomes during the first year of HD in a multinational cohort of elderly patients. Methods: Patients ≥70 years from the MONDO Initiative who commenced HD between 2000 and 2010 in Asia-Pacific, Europe, North-, and South-America and survived at least 6 months were included in this investigation. We stratified by age (70-79 years [younger] vs. ≥80 years [older]) and compared access types (at first and last available date) and their changes. We studied the association between access at initiation and conversion, respectively, and all-cause mortality using Kaplan-Meier curve and Cox regression, and predicted the absence of conversion from catheter to non-CVC using adjusted logistic regression. Results: In 14,966 elderly, incident HD patients, survival was significantly worse when using a CVC at all times. In Europe, the conversion frequency from CVC to non-CVC was higher in the younger fraction. Conversion from non-CVC to CVC was associated with worsened outcomes only in the older fraction. Conclusion: These results corroborate the need for early HD preparation in the elderly HD population. Treatment of elderly patients who commence HD with a CVC should be planned considering aspects of individual clinical risk assessment. Differences in treatment practices in predialysis care specific to the elderly as a population may influence access care and conversion rate.

Effectiveness of a New Single‐Needle Single‐Pump Dialysis System with Simultaneous Monitoring of Dialysis Dose

“…Therefore, this new single‐needle single‐pump method by increasing the amount of treated blood may be a valid alternative to double lumen catheters for elderly fragile patients. Double lumen catheters are today the most common dialysis access in patients older than 75 years . This implies a probable marginal prolongation of the treatment time, but this can be an additional advantage, as according to Saran et al , targeting a gentler dialysis treatment with lower net ultrafiltration rate is associated with lower mortality risk.…”

Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions

“…This may be weighed against the alternative of TDC where the risk of subsequent infections and flow problems is significantly increased. 8,19,20 Placement of AVF is made either as side-to-side of artery and vein or end-to-side of the vein/graft to the artery. 4,8 AVSs are normally placed end-to-side to the artery and end-to-side or end-to-end to the vein.…”

Octogenarians and Nonoctogenarians Have Similar Outcomes after Upper Extremity Hemodialysis Access Creation

“…15,16 The superiority of permanent access has been specifically demonstrated in the elderly. 7,12,17 It has been suggested that AVGs may be favorable in older populations with more comorbidities and shorter life expectancies, due to the extended maturation time of AVFs. 18,19 However, conflicting research findings showed AVFs to have similar or better outcomes as prosthetic AVGs in the elderly.…”