Vascular access for dialysis in the elderly.
OBJECTIVE
The aim of this study was to analyze early and late outcome of the first vascular accesses performed in the HGUGM of Madrid between 1992 and 1997, comparing the results in patients older and younger than 65 years.


METHODS
Retrospective study. All the vascular accesses performed in patients without previous permanent angioaccess between January 1992 and March 1997 were studied. Early failure, complication rate (patient-year of follow-up), and cumulative patency rates were analyzed.


RESULTS
The difference between grafts required in young (25%) and old patients (34%) was significant (p < 0.01). Complication rate in autologous fistulas was 0.07 per patient-year in the younger group and 0.12 per patient-year in the older (p < 0.01). Complication rate in grafts was 0.5 per patient-year in the younger group and 0.8 per patient-year in the older group (p < 0.05). There were no significant differences in patency rates for both autologous and graft accesses between patients younger or older than 65 years. Better primary patency (log-rank comparison between curves, p < 0.001), and lower complication rates (0.09 patient-year for autologous and 0.58 for grafts, p < 0.001), were observed in autologous fistulas in both groups.


CONCLUSIONS
Autologous access is the best angioaccess for dialysis also in older patients and can be performed in most patients without a previous permanent access. Yet, we observed in our experience that more grafts were needed in patients older than 65 years.
Ridao-Cano
Natalia
N
Department of Nephrology, Vascular Access Unit, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, E-28007 Madrid, Spain.
Polo
José R
JR
Polo
Jorge
J
Pérez-García
Rafael
R
Sanchez
Mercedes
M
Gómez-Campderá
Francisco J
FJ
D000206:Actuarial Analysis; D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency