Vascular access for hemodialysis in the elderly

Swindlehurst, Nicola; Swindlehurst, Andrew; Lumgair, Heather; Mesa, I. Rebollo; Mamode, Nizam; Cacciola, Roberto; Macdougall, Iain C.

doi:10.1016/j.jvs.2010.09.068

Cited by 45 publications

(50 citation statements)

References 23 publications

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“…The only reason for technique failure was vascular thrombosis in both groups [8] . Similar reports have been published by Swindlehurst et al [101] , according to which the creation of permanent HD access in the elderly with AVF is not only possible but also proved to have a short hospital stay, high patency rates and an acceptable rate of further intervention. Desilva et al [102] state that, while specific subgroups in the HD population exist where use of fistulas and grafts at time of dialysis initiation is not of proven statistical benefit to survival, elderly HD patients with comorbidities still appear to benefit from the use of fistulas and grafts.…”

Section: Mortality and Morbidity Of Vascular Accesssupporting

confidence: 83%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis (HD). Vascular access (VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula (AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most important issue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

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Section: Mortality and Morbidity Of Vascular Accesssupporting

confidence: 83%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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“…(Figure 13) Our findings suggested that there was no difference in vascular access complications across age groups and the survival of the first AV fistula was independent of age [8]. Similar reports have been published by Swindlehurst N et all according to which the creation of permanent hemodialysis access in the elderly with AVF is not only possible but also proved to have a short hospital stay, high patency rates, and an acceptable rate of further intervention [90]. 16 % more likely to be hospitalized, overall, than men.…”

Section: Vascular Access Complications and Survivalsupporting

confidence: 80%

Vascular Access for Hemodialysis

Pantelias¹,

Grapsa²

2011

Technical Problems in Patients on Hemodialysis

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“…According to our data patients over 80 years tend to have even slightly less shunt complications than younger patients. Neither did other authors find differences in the elderly [21,22], and especially in patients aged over 80 years [23,24]. Nadeau-Fredette et al reported a higher rate of primary AV-fistula failure in patients over 80 years.…”

Section: Discussionmentioning

confidence: 99%

“…But the subsequent primary patency was similar [25]. Swindlehurst et al found that grafts in the elderly had a higher cumulative patency compared to patients aged below 65 [22]. Early and close cooperation with vascular surgeons can help avoiding catheters.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis in Patients Over 80 Years

Leimbach¹,

Kron²,

Czerny³

et al. 2015

Nephron

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Background: In Germany, every fifth patient starting dialysis is now 80 years of age or older. The question that is currently relevant is not whether we have to treat patients who are older than 80. Rather the question now is how to treat this elderly group of patients. Methods: Single centre data of all dialysis patients aged over 80 were analyzed with regard to survival, social circumstances, vascular access, and pre-dialysis nephrology care. Results: Between 2001 and 2012, 76 patients over 80 years started chronic ambulatory hemodialysis treatment. One-year survival was 87%, 3-year survival 52%, 5-year survival 27% and 10-year survival 9%. Patients (n = 55) with more than 3 months of nephrological care prior to dialysis (3-161 months, median 31 months) survived significantly longer then patients (n = 21) having had less than 3 months contact with nephrologists. On 31st December 2012 there were 38 patients aged ≥80 (median age 84, 80-95 years) in the chronic hemodialysis program accounting for 19% of all dialysis patients of this center. Thirty patients (79%) had been in long-term nephrological care prior to dialysis initiation (3-161 months, median 45 months). Thirty one patients (82%) started the first dialysis treatment with a functioning shunt access. Conclusion: Long-term pre-dialysis nephrology care is of most importance for successful dialysis treatment in the elderly, especially in octogenarians and nonagenarians. It enables the early establishment of functioning vascular access and careful scheduling of first dialysis treatment and increases survival. The long-term use of catheters can be avoided in almost all patients above the age of 80.

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Vascular access for hemodialysis in the elderly

Abstract: In our experience, the creation of permanent hemodialysis access in the elderly with AVF is not only possible but also proved to have a short hospital stay, high patency rates, and an acceptable rate of further intervention.

Cited by 45 publications

References 23 publications

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