JOURNAL ARTICLE
Add like
Add dislike
Add to saved papers

Creating functional autogenous vascular access in older patients.

OBJECTIVE: Arteriovenous fistulas (AVFs) are the preferred choice for hemodialysis vascular access (AV access); however, there is debate over the utility of AVFs in older patients, particularly concerning access maturation and functionality. We reviewed our AV access experience in patients ≥65 years of age.

METHODS: We analyzed consecutive AV access patients ≥65 years old with access operations between March 2003 and December 2009. All patients had ultrasound vessel mapping. In addition to overall outcomes review, the data for patients ≥65 years old were stratified into three 10-year increments by age for further analysis. We compared functional patency data for our older patients with those of our non-elderly patients aged 21 to 64 years treated during the same time period.

RESULTS: Four hundred sixty-one consecutive AV access patients new to our practice were included in this study. Ages were 65 to 94 years (mean, 73 years). Two hundred thirty-six (51.2%) were female, 276 (59.9%) patients were diabetic, and 103 (22.3%) were obese. One hundred seven (23.2%) patients had previous access operations. Radiocephalic AVFs were constructed in 29 (6.3%) patients, 99 (21.5%) patients had brachial artery inflow AVFs, 330 (71.6%) had proximal radial artery AVFs, and three were based on the femoral artery. Transposition AVFs were used in 124 (26.9%) patients. No grafts were used for AV access in any patient during the study period. Time to AVF use was 0.5 to 6 months (mean, 1.5 months). Primary, primary assisted, and cumulative patency for patients aged 65 to 94 years were 59.9%, 93.7%, and 96.9% at 12 months and 45.3%, 90.1%, and 94.6% at 24 months, respectively. Follow-up was 1.5 to 77 months (mean, 17.0 months). Subgroup age stratification (65-74 [n = 268], 75-84 [n = 167], 85-94 [n = 26] years) found no statistical difference in functional access outcomes. Primary, primary assisted, and cumulative patency rates were not statistically different in the elderly and non-elderly populations (P = .29, .27, and .37, respectively). One hundred fifty-six patients died during the study period, 1.3 to 61 months (mean, 20 months) after access creation. No deaths were related to access operations.

CONCLUSIONS: AVFs are feasible and offer functional and timely AV access in older patients. There was no difference in functional access outcomes for older patients with subgroup age stratification. AVF patency rates were not statistically different in the elderly and non-elderly populations. Cumulative AVF patency for patients ≥65 years of age was 96.9% at 12 months and 94.6% at 24 months.

Full text links

For the best experience, use the Read mobile app

Group 7SearchHeart failure treatmentPapersTopicsCollectionsEffects of Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart Failure Importance: Only 1 class of glucose-lowering agents-sodium-glucose cotransporter 2 (SGLT2) inhibitors-has been reported to decrease the risk of cardiovascular events primarily by reducingSeptember 1, 2017: JAMA CardiologyAssociations of albuminuria in patients with chronic heart failure: findings in the ALiskiren Observation of heart Failure Treatment study.CONCLUSIONS: Increased UACR is common in patients with heart failure, including non-diabetics. Urinary albumin creatininineJul, 2011: European Journal of Heart FailureRandomized Controlled TrialEffects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.Review

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app