Vascular access in older patients:  an Italian survey

Venturelli, Chiara; Bandera, Andrea; Zubani, Roberto; Movilli, Ezio; Veniero, P.; Gaggiotti, Mario; Gregorini, Gina; Cancarini, Giovanni; Brunori, Giuliano

doi:10.5301/jn.5000264

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…A knowledge of the different surgical techniques [53] is helpful in making the nephrologist a more active proponent of AVF creation. As demonstrated in a recent Italian survey, AVF still remains the dialysis access with highest prevalence also in older patients, with an excellent survival rate [55]. Again, the Italian data from the DOPPS study confirm the high rate of AVFs both in the prevalent and, more importantly, in incident patients [56].…”

Section: An Italian Perspectivementioning

confidence: 74%

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

et al. 2016

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The incident hemodialysis (HD) population is aging, and the elderly group is the one with the most rapid increase. In this context it is important to define the factors associated with outcomes in elderly patients. The high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and congestive heart failure, usually make vascular access (VA) creation more difficult. Furthermore, many of these patients may have an insufficient vasculature for fistula maturation. Finally, many fistulas may never be used due to the competing risk of death before dialysis initiation. In these cases, an arteriovenous graft and in some cases a central venous catheter become a valid alternative form of VA. Nephrologists need to know what is the most appropriate VA option in these patients. Age should not be a limiting factor when determining candidacy for arteriovenous fistula creation. The aim of this position statement, prepared by experts of the Vascular Access Working Group of the Italian Society of Nephrology, is to critically review the current evidence on VA in elderly HD patients. To this end, relevant clinical studies and recent guidelines on VA are reviewed and commented. The main advantages and potential drawbacks of the different VA modalities in the elderly patients are discussed.

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Section: An Italian Perspectivementioning

confidence: 74%

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

et al. 2016

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“…This contrasts with an Italian survey where CVC significantly affects mortality. 9 Age was the only statistically significant factor associated with death (p=0.045) which is comparable to the Italian population (p<0.001). 9 In contrast, the mortality benefit of AVF is consistently superior to that of AVG and CVC for patients of all ages.…”

Section: Discussionmentioning

confidence: 58%

“…7 A recent survey on the Italian population showed no difference in fistula outcome in old age with primary patency of 73 %, 8 contrary to Richardson et al, reported, who reported primary patency of 35 % at one year. 9 The currently available literature concludes that every centre has variable outcomes and optimum hemodialysis access for the elderly population is yet to be defined. 10 Therefore, the present study aimed to determine the outcome of arteriovenous-fistula in our elderly population as per the latest KDOQI guidelines and compares it with younger age groups so that the best approach to hemodialysis access can be defined.…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis Access Outcome in Elderly Population and its Association with Mortality

Arif

Bhatti²,

Sohail³

et al. 2022

PAFMJ

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Objective: to determine the outcome of arteriovenous fistula in the elderly compared to the younger age group and its association with mortality so that the best approach to hemodialysis access can be defined. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Vascular Surgery, CMH, Lahore Pakistan, from Jan 2020 to Aug 2021. Methodology: All the Patients who presented to access the Surgical Clinic were categorized into three groups according to their age. Outcome variables like fistula maturation, complications and mortality were compared according to age groups. Result: A total of 184 patients were recruited. We found that in the age group >70 years, there was male predominance (12, 54.5%), three-quarters of them were on hemodialysis at the time of access surgery, only half of them were functional at one year of follow-up, and 6 (27.3%) were not alive at the time of contact. In addition, the pseudo aneurysm was the most common complication in this group, which was the most dreadful of all access-related complications and further put the already frail at risk. Conclusion: No single optimal approach can be expected to meet the needs of all, and an extensive patient-centred case-based discussion is required for each patient in the hope that optimal dialysis access can be created. Age cannot be defined as an independent risk factor for access creation.

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“…The percentage of patients who are using a native arteriovenous fistula as a vascular access varies remarkably between Europe and the United States (US). It is interesting to note, that the use of AV fistulas is much more common in Europe than in the US, while patients on hemodialysis have lower comorbidity in Europe than in the US as it was shown in the DOPPS study [12]. More than half of the US dialysis patients receive a synthetic arteriovenous graft.…”

Section: Arteriovenous Fistulasmentioning

confidence: 89%

Vascular Access for Hemodialysis: When and how?

2014

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As chronic kidney disease (CKD) progresses to the terminal stage, proper actions must be taken to prepare the patient for the initiation of the renal replacement therapy (RRT). If hemodialysis is an option for RRT, decisions should be made about the right vascular access for each individual patient. The available options for vascular access include the use of native arteriovenous fistulas (AVF), synthetic arteriovenous grafts (AVG) and double lumen dialysis catheters. With the help of ultrasound mapping, chances for choosing a right access are today very high. For hemodialysis patients the selection of the proper vascular access is of vital issue in regard of preventing complications and unnecessary procedures. Planning, creation and monitoring of the vascular access in dialysis patients should involve not only the nephrologist, but also the vascular surgeon and the interventional radiologist. Thus, multidisciplinary approach should be taken, in order to choose the way that has the most advantages and the least damage for the patient. That is the proper mode for hemodialysis patients to have longer and better quality of life.

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Vascular access in older patients:  an Italian survey

Abstract: A fistula is the gold standard for hemodialysis vascular access in older patients if judged appropriately.

Cited by 5 publications

References 15 publications

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

Hemodialysis Access Outcome in Elderly Population and its Association with Mortality

Vascular Access for Hemodialysis: When and how?

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Vascular access in older patients: an Italian survey

Abstract: A fistula is the gold standard for hemodialysis vascular access in older patients if judged appropriately.

Cited by 5 publications

References 15 publications

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

Hemodialysis Access Outcome in Elderly Population and its Association with Mortality

Vascular Access for Hemodialysis: When and how?

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Resources

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Vascular access in older patients:  an Italian survey