Mortality benefits of different hemodialysis access types are age dependent

Hicks, Caitlin W.; Canner, Joseph K.; Arhuidese, Isibor; Zarkowsky, Devin S.; Qazi, Umair; Reifsnyder, Thomas; Black, James H.; Malas, Mahmoud B.

doi:10.1016/j.jvs.2014.07.091

Cited by 75 publications

(56 citation statements)

References 31 publications

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“…The elderly have specific health care requirements, as they are at increased risk of comorbidities that may result in frailty and reduced physical and cognitive function; furthermore, they often face complex psychosocial, financial, and transportation issues [28]. The creation and use of a VA in elderly patients requires the complex integration of patient, biological and surgical factors because the VA type might be a key factor influencing their survival [2, 9, 22, 29]. Data from the ERA-EDTA registry show that the likelihood of being treated with an AVF was 20, 24 and 37 % lower in the three oldest patient age-groups (60–69, 70–79 and >80 years) when compared to patients aged 22–44 years [30].…”

Section: Va In Elderly Patients: Recent Findingsmentioning

confidence: 99%

“…In fact, VA planning in the elderly is different from that in younger patients, and the Fistula First Initiative may not be the preferred approach for older patients because of their reduced life expectancy and conflicting results after surgery [8]. Although AVF may be superior to arteriovenous graft (AVG) and central venous catheter (CVC) in all age groups, including the elderly, many elderly patients have a heavy burden of comorbidities and insufficient vasculature for fistula maturation, resulting in a reduced rate of AVF patency [9]. Patients over 65 years have a fistula failure rate double that of younger patients [10]; furthermore, many fistulas will never be used due to the competing risk of death before dialysis initiation in this group [11].…”

Section: Introductionmentioning

confidence: 99%

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The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

et al. 2016

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The incident hemodialysis (HD) population is aging, and the elderly group is the one with the most rapid increase. In this context it is important to define the factors associated with outcomes in elderly patients. The high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and congestive heart failure, usually make vascular access (VA) creation more difficult. Furthermore, many of these patients may have an insufficient vasculature for fistula maturation. Finally, many fistulas may never be used due to the competing risk of death before dialysis initiation. In these cases, an arteriovenous graft and in some cases a central venous catheter become a valid alternative form of VA. Nephrologists need to know what is the most appropriate VA option in these patients. Age should not be a limiting factor when determining candidacy for arteriovenous fistula creation. The aim of this position statement, prepared by experts of the Vascular Access Working Group of the Italian Society of Nephrology, is to critically review the current evidence on VA in elderly HD patients. To this end, relevant clinical studies and recent guidelines on VA are reviewed and commented. The main advantages and potential drawbacks of the different VA modalities in the elderly patients are discussed.

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Section: Va In Elderly Patients: Recent Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

et al. 2016

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“…In a study of patients with end-stage renal disease, spline modeling showed that hemodialysis access outcomes differed at an age cutoff of 89 years. 28 Similarly, spline modeling analyses may also be able to assist in determining a precise cutoff at which AAA repair becomes too risky to pursue. However, before such a study can be performed, the accepted costs and acceptable predicted risk value associated with AAA repair must be established and agreed upon.…”

Section: Discussionmentioning

confidence: 99%

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Hicks

Obeid

Arhuidese

et al. 2016

Journal of Vascular Surgery

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“…Patients who did not have valid values for this data item were dropped from the analysis. We retained patients who survived at least 90 days after initiation of HD, consistent with other USRDS survival analyses (13,15). Demographic data were analyzed using chi-square statistics for dichotomous variables and the Kruskal-Wallis equality-of-populations rank test for continuous variables.…”

Section: Methodsmentioning

confidence: 99%

Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation

Yuo

Chaer

Dillavou

et al. 2015

Journal of Vascular Surgery

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OBJECTIVES Current guidelines suggest that arteriovenous fistula (AVF) is associated with survival advantage over arteriovenous grafts (AVG). However, AVF often require months to become functional, increasing tunneled dialysis catheter (TDC) use, which can erode the benefit of AVF. We sought to compare survival in ESRD patients after creation of AVF or AVG in patients starting hemodialysis (HD) with TDC and identify patient populations that may benefit from preferential use of AVG over AVF. METHODS Using U.S. Renal Data System (USRDS) databases, we identified incident HD patients in 2005 through 2008 and followed them through 2008. Initial access type and clinical variables including albumin levels were assessed using USRDS data collection forms. Attempts at AVF and AVG creation in patients who started HD through TDC were identified by CPT codes. We accounted for the effect of changes in access type by truncating follow-up when additional AVF or AVG were performed. Survival curves were then constructed, and log-rank tests used for pairwise survival comparisons, stratified by age. Multivariate analysis was performed with Cox proportional hazards regressions; variables were chosen using stepwise elimination. An interaction of access type and albumin level was detected, and Cox models using differing thresholds for albumin level were constructed. The primary outcome was survival. RESULTS Among the 138,245 patients who started with TDC and had complete records amenable for analysis, 22.8% underwent AVF creation (Mean age±SD: 68.9±12.5 years, 27.8% mortality at 1 year) and 7.6% underwent AVG placement (70.2±12.0 years, 28.2% mortality) within 3 months of HD initiation; 69.6% remained with TDC (63.2±15.4 years, 33.8% mortality). In adjusted Cox proportional hazards regression, AVF creation is equivalent to AVG placement in terms of survival (HR 0.98, 95% CI 0.93–1.02; P=.349). AVG placement is superior to continued TDC use (HR 1.54, 95% CI 1.48–1.61; P<.001). In patients over age 80 with albumin levels greater than 4.0 g/dL, AVF creation is associated with higher mortality hazard compared to AVG creation (HR1.22, 95% CI 1.04–1.43, P=.013). CONCLUSIONS For patients that start HD through TDC, placement of AVF and AVG are associated with similar mortality hazard. Further study is necessary in order to determine the ideal access for patients in whom the survival advantage of AVF over AVG is uncertain.

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Mortality benefits of different hemodialysis access types are age dependent

Cited by 75 publications

References 31 publications

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation

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