The Effect of Patient Age and Other Factors on the Maintenance of Permanent Hemodialysis Vascular Access

Abstract

The objective of the present study was to investigate whether patient age is associated with vascular access failure during maintenance hemodialysis. Thus, patients who had a successful permanent hemodialysis vascular access installed (Group N: 314 cases), and those who required vascular access revision (Group R: 108 patients) were studied. To assess the association between patient age and the risk of vascular access failure, Cox proportional hazards regression was used to determine hazard ratios (HR) and 95% confidence intervals (CI). We found that in Group N, the significant risk factors were age, gender, and diabetes mellitus (95% CI: 1.004-1.013, 0.380-0.827, 1.279-2.859). Using a univariate analysis model, significant hazard ratios (HR) were found with ages of 60 (CI: 1.062-2.302), 65 (CI: 1.052-2.280), and 70 (CI: 1.082-2.537) years, with the largest HR at 70 years of age (HR: 1.657). In contrast, in Group R, multivariate analysis using Cox proportional hazards identified only one prognostic variable, the location of the vascular access. In Group R, univariate analysis models showed that age was not a significant factor. We conclude that our data show that age is a risk factor for the successful maintenance of initial permanent hemodialysis vascular access. Other risk factors include gender and diabetes mellitus. However, these factors were not related to the successful maintenance of revised vascular access.

Influence of diabetes and perivascular allogeneic endothelial cell implants on arteriovenous fistula remodeling

“…19,20,23,24 Hayakawa and colleagues recently reported that diabetes, in addition to patient age and gender, was a risk factor for successful maintenance of an initial permanent vascular access. 25 These results were confirmed in a study by Gheith et al where both radial and brachial AVFs survived significantly longer in nondiabetic than in diabetic patients. 20 However, other authors have not found an independent association between diabetes and AVF function.…”

Initial Vascular Access Type in Patients with a Failed Renal Transplant

“…Patients who had a higher associated risk of starting with a CVC included women, institutionalized patients, patients with diabetes and peripheral vascular disease, and patients not referred to a nephrologist. Women, diabetes, and peripheral vascular disease are traditional risk factors associated with poor maturation rates of AVF; however, lack of referral to a nephrologist and care for institutionalized patients are broader system-wide issues that need to be addressed (28)(29)(30)(31)(32). Interestingly, those same risk factors were associated with a lower likelihood of having a permanent AV access in place and used at the time of initiation of dialysis.…”

Significant Correlation between Ankle-Brachial Index and Vascular Access Failure in Hemodialysis Patients

“…Stenosis was observed most commonly at the arteriovenous anastomosis (42). The differences in the incidence and distribution of vascular stenosis are affected by many factors, such as age, the diagnosis of DM, vascular access type, and surgeon's experience (28,43,44). In our study, we divided the patients with VAF into two subgroups, including stenosis at the site of arteriovenous anastomosis (within 3 cm of the anastomosis) and site distant from anastomosis to evaluate the correlation between ABI Ͻ0.9 and VAF in different stenosis sites.…”