Selective placement of autogenous arteriovenous fistulae in an over 80-year-old population

Werner-Gibbings, Keagan; Ischia, Liesl; Butcher, W.; Ward-Harvey, Richard; Stewart, J.H.; Jackson, Mark

doi:10.5301/jva.5000807

Cited by 4 publications

(12 citation statements)

References 34 publications

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“…It is widely known that AVFs are the VA of choice, representing greater permeability and a lower rate of complications. However, the increase in the number of older dialysis patients, with greater comorbidity and limited life expectancy, forces us to consider what the “ideal” VA is in this population 16–18 . In order to avoid relevant VA complications and unnecessary surgical procedures, recent clinical guidelines suggest the concept of “the right patient, the right treatment, the right access, and the right time.” This concept aims to offer the most appropriate VA according to the clinical characteristics of the patient to a greater degree than by simply following the “one‐size‐fits‐all” traditional indications established in the previous VA guidelines 27–29 …”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15] There is currently no consensus on which VA is best for this population, or whether postoperative isometric exercises should be considered. [16][17][18][19][20] Therefore, the aim of our study was to assess the role of a postoperative isometric exercises program on native VA maturation and medical or surgical related complications in an elderly population with advanced chronic kidney disease (CKD; stage 5 or 5D).…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, in the elderly population, several cardiovascular risk factors and comorbidities make VA management difficult in this population, particularly with regard to the maturation process and related complications 11–15 . There is currently no consensus on which VA is best for this population, or whether postoperative isometric exercises should be considered 16–20 . Therefore, the aim of our study was to assess the role of a postoperative isometric exercises program on native VA maturation and medical or surgical related complications in an elderly population with advanced chronic kidney disease (CKD; stage 5 or 5D).…”

Section: Introductionmentioning

confidence: 99%

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Elderly patients, isometric exercise, and native vascular access maturation: An unsolved question?

González

Simó

Ibañez

et al. 2020

Hemodialysis International

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Introduction: The number of elderly patients undergoing hemodialysis is steadily increasing. The choice and management of vascular access (VA) in these patients are difficult, and the role of postoperative isometric exercises on native VA maturation in the elderly population is not clearly established. Objectives: To assess the effect of postoperative isometric exercises on native VA maturation in patients older than 75 years with advanced chronic kidney disease. Methodology: This was a randomized single-center study over a 24-month period. Postoperative isometric exercises were performed in the exercise group (EG), while the control group (CG) received usual care. Demographic data, muscle strength (using handgrip [HG] dynamometer), Doppler ultrasound (DUS), incidence of VA complications, and clinical and DUS maturation were assessed at 4 and 8 weeks. Results: A total of 27 patients were included (EG: 14, CG: 13). The mean age of the patients was 79.9 AE 2.8 years; 74.1% were men, and 59.2% had radiocephalic VA. Demographic data, HG, and DUS measurements were similar at baseline. DUS measurements significantly increased in both groups at the end of the study. A significant increase in HG (19.1 AE 7.8 kg vs. 22.9 AE 9.7 kg, P = 0.001) and the highest clinical (CG vs. EG: 46.2% vs. 78.6%; P = 0.049) and DUS maturation (CG vs. EG: 30.8% vs. 71.4%; P = 0.041) were observed in the EG at 8 weeks. Globally, medical or surgical VA complications were lower in the EG and mainly included significant stenosis (CG vs. EG: 23.1% vs. 7.1%), although no significant differences were observed. Conclusions: Once a native VA is indicated in elderly patients, postoperative isometric exercise should be considered in order to improve the odds of achieving a mature functional arteriovenous fistula. Further studies are required to support our findings in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Elderly patients, isometric exercise, and native vascular access maturation: An unsolved question?

González

Simó

Ibañez

et al. 2020

Hemodialysis International

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Section: Description Of the Consensusmentioning

confidence: 99%

“…Therefore, although AVF has a lower patency rate and higher intervention rate in older patients than in younger patients, in selected elderly patients, AVF is more suitable for long-term vascular access for HD than CVC, and age itself, in particular, should not be an exclusion criterion for AVF surgery. 37 A South Korean study on the impact of age on AVF maturity and patency rate included 130 elderly (age 70 years) and 293 young patients. Successful AVF puncture performed twice was defined as mature.…”

Section: Consensus Contentmentioning

confidence: 99%

Expert consensus on the establishment and maintenance of native arteriovenous fistula

Zhang

et al. 2021

Chronic Diseases and Translational Medicine

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Vascular access is the lifeline of hemodialysis patients. There are great differences in the establishment and use of vascular access in different countries and regions around the world. We believe that on the basis of good evaluation and planning, it is recommended that hemodialysis patients choose native arteriovenous fistula first. In view of the new progress of vascular access views domestic and international at home and abroad in recent years, we organized experts to recommend the establishment and maintenance of arteriovenous fistula (AVF) for the Chinese population, including preoperative evaluation and planning of the establishment of AVF, AVF surgery, perioperative drug intervention measures and postoperative maintenance, and put forward suggestions for future research directions. The recommendations in this consensus are general and clinicians need to make treatment decisions based on the actual situation.

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Hemodialysis vascular access in elderly patients: A comprehensive review

et al. 2022

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The number of elderly patients initiating hemodialysis (HD) increased considerably over the past decade. Arteriovenous fistulas (AVFs) are the preferred vascular access (VA) type in most HD patients. Choice of VA for older hemodialysis patients presents a challenge. The higher incidence of comorbidities, longer AVF maturation times, risk of primary failure, risk of patency loss, and shorter life expectancy are important factors to consider. In this review we provide a comprehensive analysis on maturation rates, primary failure, patency, and mortality regarding vascular access in patients older than 75 years of age.

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Selective placement of autogenous arteriovenous fistulae in an over 80-year-old population

Abstract: Although patency rates are inferior and re-intervention rates higher than in younger patients, AVF can be a durable option for RRT in selected elderly patients with improved mortality rates compared with CVC. Age alone should not preclude primary AVF placement.

Cited by 4 publications

References 34 publications

Elderly patients, isometric exercise, and native vascular access maturation: An unsolved question?

Elderly patients, isometric exercise, and native vascular access maturation: An unsolved question?

Expert consensus on the establishment and maintenance of native arteriovenous fistula

Hemodialysis vascular access in elderly patients: A comprehensive review

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