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

Dicken, Quinten; Sather, Kristiana; Farber, Alik; Mendez, Logan; Castro, Victor; Zhang, Yixin; Levin, Scott R.; Talutis, Stephanie D.; Raulli, Stephen J.; Siracuse, Jeffrey J.

doi:10.1016/j.avsg.2020.06.035

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…Their results support the primary placement of brachiocephalic AVF in the elderly due to improved assisted patency compared to the other AVFs ( p = 0.016). In contrast, Dicken et al 18 enrolled 660 patients (620 non-octogenarians and 40 octogenarians) submitted to similar vascular access types (RCAVF, brachiocephalic AVF, brachiobasilic AVF, and arteriovenous graft) finding out no differences between the two groups in terms of maturation ( p = 0.93), reintervention-free survival ( p = 0.47), and occlusion-free survival ( p = 0.62), suggesting that advanced age should not influence the choice of dialysis access.…”

Section: Discussionmentioning

confidence: 88%

Outcomes of radiocephalic arteriovenous fistula in octogenarians

Mauro

Pini

et al. 2021

J Vasc Access

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Background: Current guidelines recommend radiocephalic arteriovenous fistula (RCAVF) as a first choice access for hemodialysis, without specific indication for octogenarians .This study was undertaken to assess the efficacy of RCAVF in octogenarians compared with younger patients. Material and methods: All patients treated by RCAVF from January 2013 to December 2017 were included in a prospective database for a retrospective analysis. Patient demographics, comorbidities, and dialytic treatment data were collected prospectively and compared in patients <80 year-old and ⩾80 years-old. Clinical surveillance was performed during each dialysis session. The main endpoints were primary (PP) and assisted patency (AP). Results: Within the study period, a total of 294 RCAVF were analyzed: 245 (83.3%) RCAVF were performed in <80 year-old and 49 (16.7%) ⩾80 years old. The overall PP and AP at 2-year was 69% ± 2% and 73% ± 3%, respectively. Patients ⩾ 80 years-old had a significantly reduced 2-year PP, AP of RCAVF compared with the younger patients: 50% ± 8% and 62% ± 7% versus 73% ± 3% and 75% ± 3%, p = 0.01 and p = 0.03, respectively. The analysis for possible risk factors for reduction of PP in patients ⩾80 years identified in the central venous catheter(CVC) a predictor of earlier RCAVF failure: HR 3.03(95% CI 1.29–7.13), p = 0.01.Kaplan–Meier curve confirms the reduction of PP in ⩾80 years old patients at 2-year follow-up with previous CVC compared patients without history of CVC: 59% ± 10% versus 24% ± 11%, p = 0.01. A comparison between the two groups was made in order to evaluate the impact of previous history of CVC .In absence of a history of CVC use older patients had a similar 2-year PP compared with younger patients: 59% ± 10% versus 72% ± 4%, p = 0.46. Otherwise, the history of a previous CVC reduced significantly the 2-year PP in ⩾80 years old patients compared the younger: 24% ± 12% versus 75% ± 5%, p = 0.0001. Conclusions: Despite lower overall primary and primary assisted patency, RCAVF are associated with satisfactory results also in octogenarians if performed in absence of history of CVC. Under these circumstances RCAVF can be considered a first choice treatment.

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Section: Discussionmentioning

confidence: 88%