Patient Survival following Arteriovenous Fistula Formation

McGrogan, Damian; Field, Melanie; Maxwell, Alexander P.; Marie, Yazin; Inston, Nicholas

doi:10.5301/jva.5000343

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…A counterview to this is the shortened life expectancy of elderly patients on maintenance hemodialysis as they may not survive to need a second AVF. [910] Moreover the maturation rates of AVF are poorer in older patients because of high incidence of diabetes and hypertension leading to poorer vascular endothelial health accompanied with higher incidence of peripheral vascular disease resulting in impairment of blood inflow to AVF. [11]…”

Section: Introductionmentioning

confidence: 99%

Outcomes of primary arteriovenous fistula for hemodialysis in elderly patients (>65 Years) with end stage renal disease: A study on Indian population

Gaur¹,

Srivastava²,

Sureka³

et al. 2019

Indian J Nephrol

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Introduction:The outcome of arteriovenous fistula (AVF) for hemodialysis (HD) in elderly population remains an issue. The aim of our study was to evaluate the outcomes of arteriovenous fistulas created at our institute in patients older than 65 years.Methods:All chronic HD patients with age >65 years who had an AVF created between January 1, 2010 and January 1, 2017 were included retrospectively. Baseline demographic information including age, gender, etiology of renal failure and comorbidities were recorded. Access characteristics including access type and anatomic location were recorded. The end point of study was primary and secondary patency. Minimum follow up period of study was 1 year.Results:A total of 422 AVF were created within the study period. The mean age was 69.3 years. The anatomical site of AVF creation was radiocephalic (RCF) in 74.8% (n = 316), brachiocephalic (BCF) in 18.9% (n = 80) and brachiobasilic (BBF) in 6.1% (n = 26). At one year after creation, cumulative survival of the AVF was 64.7%. At 36 months the primary and secondary patency of RCF, BCF and BBF was 43.6%, 58.6%, 42.6% and 47.3%, 62.5%, 56.9% respectively. The overall median survival did not differ between RCF and BBF fistulas. However, when both were compared with BCF (median survival 1034 days), BBF (median survival 741 days) and RCF (median survival 592 days) had significantly poorer survival (P = 0.004). The most common reason for access failure was thrombosis (28.4%) followed by failure to mature (9%) and aneurysm related complications (9%).Conclusions:Age should not be a limiting factor when choosing AVF as the preferred HD access. Brachiocephalic AVF has better primary and secondary patency with higher overall median survival. However RCF also provides reasonably good survival rates with acceptable complications in elderly population. Thrombosis and fistulas that fail to mature present as a primary concern to patients in elderly population, and demand further study.

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Section: Introductionmentioning

confidence: 99%

Outcomes of primary arteriovenous fistula for hemodialysis in elderly patients (>65 Years) with end stage renal disease: A study on Indian population

Gaur¹,

Srivastava²,

Sureka³

et al. 2019

Indian J Nephrol

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“…1 Given the limited life span of arteriovenous fistulas (AVFs), the approach to access planning has been primarily to use the smaller distal arterial vessels, preserving the proximal vessels for future use. However, elderly patients commencing dialysis have a significantly higher mortality, reported to be as high as 29.1% 2 1 year after AVF creation and >50% at 2 years after commencing hemodialysis. 3 Older patients have an increased incidence of comorbidities including diabetes, hypertension, and peripheral vascular disease.…”

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confidence: 99%

Arteriovenous fistula outcomes in the elderly

McGrogan

Shakarchi

Khawaja

et al. 2015

Journal of Vascular Surgery

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“…Even where a successful fistula is created it may never be used due to failure to mature or due to death of the patient before reaching the requirement for dialysis. 14,16,17…”

Section: Introductionmentioning

confidence: 99%

Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

Kuningas¹,

Inston

2021

J Vasc Access

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Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

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Patient Survival following Arteriovenous Fistula Formation

Cited by 7 publications

References 21 publications

Outcomes of primary arteriovenous fistula for hemodialysis in elderly patients (>65 Years) with end stage renal disease: A study on Indian population

Outcomes of primary arteriovenous fistula for hemodialysis in elderly patients (>65 Years) with end stage renal disease: A study on Indian population

Arteriovenous fistula outcomes in the elderly

Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

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