Survival and Complications of Arteriovenous Fistula Dialysis Access in an Elderly Population

Borzumati, Maurizio; Funaro, Loredana; Mancini, E.; Resentini, Valerio; Baroni, A

doi:10.5301/jva.5000143

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…We found that in the order of survival of AVF—nondominant radial, non‐dominant brachial, dominant radial, and dominant brachial respectively. A distal AVF may have higher survival rates owing to the presence of multiple venous escapes, 16 reduced occurrence of high flow access complications, or due to absence of steal phenomenon 17 . Similar results were seen by Borzumati et al 17 …”

Section: Discussionsupporting

confidence: 59%

A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis

Jothi

Kg²,

Lesley

et al. 2020

Seminars in Dialysis

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Introduction: Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure. Methods: Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end‐to‐side variety. Parameters studied were age, gender, diabetes mellitus, hypertension prior to end‐stage kidney disease (ESKD), site of fistula, blood flow rate, venous pressure, dialysis vintage and frequency, needle gauge used during dialysis, year of fistula creation, and details of fistula failure. Findings: The 6‐month, 1‐year and 2‐year AVF survival rates were 98.41%, 95.01%, and 89.57%. Failure rates were 17.2%, 5.5%, 26.8%, and 14.4% for dominant radial, non‐dominant radial, dominant brachial and non‐dominant brachial respectively (P < 0.001). Using a larger needle size had better AVF survival rate (P < 0.05). All other factors had no significant correlation with AVF failure. Conclusion: There were no statistically significant differences in AVF patency with respect to gender, age, blood flow rate, presence of diabetes mellitus or systemic hypertension. A distally placed AVF in the nondominant arm had the best survival rate. Using a larger needle size, specifically 15G during dialysis, was associated with lowest AVF failure.

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Section: Discussionsupporting

confidence: 59%

A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis

Jothi

Kg²,

Lesley

et al. 2020

Seminars in Dialysis

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“…18 However, other studies have suggested that age does not have an important impact on fistula outcomes. 19-22 In a retrospective study of 658 patients referred for fistula creation, Weale et al 22 assessed the impact of age on functional outcomes and found no difference in primary or secondary patency with radiocephalic and brachiocephalic fistulas in patients less than 65 years of age, 65 to 69 years of age, and those 80 years of age and older. Inconsistency in prior studies may relate to sample size considerations, a preponderance of single-center studies, differences in definitions, and the lack of adequate risk adjustment for other important predictors of fistula outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have focused on standard definitions of usability, and primary and secondary patency of fistulas. 13-21 We opted for a more pragmatic definition of successful fistula creation. The expressed intent of fistula creation is to spare patients of the complications associated with indwelling catheters.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Age on the Likelihood of Catheter-Free Fistula Use in Hemodialysis Patients

Ladak

Ravani

Oliver

et al. 2019

Can J Kidney Health Dis

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Background: Clinical practice guidelines recommend arteriovenous fistulas as the preferred form of vascular access for hemodialysis. However, some studies have suggested that older age is associated with poorer fistula outcomes. Objective: We assessed the impact of age on the outcomes of fistula creation and access-related procedures. Design: This was a prospective cohort study using data collected as part of the Dialysis Measurement Analysis and Reporting (DMAR) system. Setting: Participating Canadian dialysis programs, including Southern Alberta Renal Program, Manitoba Renal Program, Sunnybrook Health Sciences Centre (Toronto, Ontario), London Health Sciences Centre (London, Ontario), and The Ottawa Hospital (Ottawa, Ontario). Patients: Incident hemodialysis patients aged 18 years and older who started dialysis between January 1, 2004, and May 31, 2012. Measurements: The primary outcome was the proportion of all first fistula attempts that resulted in catheter-free fistula use, defined as independent use of a fistula for hemodialysis (ie, no catheter in place). Secondary outcomes included the time to catheter-free fistula use among patients with a fistula creation attempt, total number of days of catheter-free fistula use, and the proportion of a patient’s hemodialysis career spent with an independently functioning fistula (ie, catheter-free fistula use). Methods: We compared patient characteristics by age group, using t tests or Wilcoxon rank sum tests, and chi-square or Fisher exact tests, as appropriate. Logistic and fractional logistic regression were used to estimate the odds of achieving catheter-free fistula use by age group and the proportion of dialysis time spent catheter-free, respectively. Results: A total of 1091 patients met our inclusion criteria (567 age ≥ 65; 524 age < 65). Only 57% of first fistula attempts resulted in catheter-free fistula use irrespective of age (adjusted odds ratio [OR]≥65vs<65: 1.01; P = .93). The median time from hemodialysis start to catheter-free use of the first fistula did not differ by age when grouped into fistulas attempted pre- and post-dialysis initiation. The adjusted rates of access-related procedures were comparable (incidence rate ratio [IRR]≥65vs<65: 0.95; P = .32). The median percentage of follow-up time spent catheter-free was similar and low in patients who attempted fistulas (<65 years: 19% vs ≥65 years: 21%; P = .85). Limitations: The relatively short follow-up time may have underestimated the benefits of fistula creation and the observational study design precludes inferences about causality. Conclusions: In our study, older patients who underwent a fistula attempt were just as likely as younger patients to achieve catheter-free fistula use, within a similar time frame, and while requiring a similar number of access procedures. However, the minority of dialysis time was spent catheter-free.

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“…3 However, one study has shown that patients older than 75 years with autogenous vascular access can have patency that is similar to that of younger patients. 4 Notwithstanding current recommendations, there has been a recent trend away from the Fistula First Initiative in the age group older than 80 years, 5 with age being one of the four predictive factors used by Lok et al to predict failure to mature in fistulas. 6 In our center, the patient's age has not been a consideration in the decision to construct arteriovenous hemodialysis access, with the oldest patient to have access surgery aged 94 years.…”

mentioning

confidence: 99%

Vascular access in hemodialysis patients older than 80 years

Olsha

Hijazi

Goldin

et al. 2015

Journal of Vascular Surgery

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Contrary to recent recommendations favoring grafts for hemodialysis in patients older than 80 years, most elderly patients in this study were found to have vasculature that was suitable for autogenous access construction, with patency rates similar to those of their younger counterparts when adequate preoperative planning and postoperative maintenance were carried out. Age alone should not disqualify patients older than 80 years from access surgery for hemodialysis, nor should age disqualify these patients from the Fistula First Initiative.

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Survival and Complications of Arteriovenous Fistula Dialysis Access in an Elderly Population

Cited by 18 publications

References 16 publications

A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis

A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis

The Influence of Age on the Likelihood of Catheter-Free Fistula Use in Hemodialysis Patients

Vascular access in hemodialysis patients older than 80 years

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