title: Pre-emptive angioaccess for haemodialysis in the elderly.
abstract: BACKGROUND
  The fastest growing population group in the UK is the elderly, particularly those aged ≥ 80 years. The primary aim of this study was to assess if age was a determining factor for successful first dialysis through a pre-emptive angioaccess. The secondary aim was to investigate what risk factors are associated with angioaccess failure and to assess their patency and complications in three different age groups of patients who had pre-emptive angioaccess.
  
  
  METHODS
  The study was carried out retrospectively on prospectively collected data for the period January 2006-December 2007. The study population included all patients who had pre-emptive angioaccess for haemodialysis during the time frame of the study. They were divided into three age groups including a control group (A) with age <70 years, a young old group (B) (70-79 years) and an old group (C) (≥80 years). Primary failure and primary, assisted primary and secondary patency rates were ascertained and compared using the Kaplan-Meier curves and log-rank testing.
  
  
  RESULTS
  Of 243 patients who had a pre-emptive vascular access, 110 (45%), 82 (35%) and 51 (21%) patients were in Groups A, B and C, respectively. The rates of successful first dialysis through the angioaccess, excluding patients not in end-stage renal disease yet, or those who received pre-emptive kidney transplant were 88, 71 and 87% for Groups A, B and C, respectively (P > 0.05). There were six deaths before dialysis could be commenced. The primary, assisted primary and secondary patency rates after 12, 24 and 36 months did not show any significant difference between the groups (P > 0.05).
  
  
  CONCLUSIONS
  Elderly patients should be considered for angioaccess as first line of venous access. Our study showed a successful first dialysis with angioaccess with failure and patency rates comparable to other age groups. However, we still recommend that patients >80 years old be assessed on a case-by-case basis.
authors.affiliation: Renal Transplant Unit, St George’s Hospital, London, UK. mohamed.morsy@stgeorges.nhs.uk
authors.forename: Mohamed
authors.initials: M
authors.lastname: Morsy
authors.forename: Dibendu
authors.initials: D
authors.lastname: Betal
authors.forename: Stephen
authors.initials: S
authors.lastname: Nelson
authors.forename: Hazel
authors.initials: H
authors.lastname: Malete
authors.forename: Andrea
authors.initials: A
authors.lastname: Whitmore
authors.forename: Eric
authors.initials: E
authors.lastname: Chemla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D014654:Vascular Patency