title: Re-evaluating the Fistula First Initiative in Octogenarians on Hemodialysis.
abstract: OBJECTIVE
  Octogenarians frequently require maintenance hemodialysis (HD) for treatment of stage renal disease ESRD. Although the Fistula First Initiative recommends creating an arteriovenous fistula as the preferred dialysis access method, vascular access selection should be based on life expectancy and functional status at treatment initiation.
  
  
  METHODS
  This is a retrospective analysis of 4-year outpatient data (January 1, 2004 through December 31, 2007) of incident octogenarian dialysis population in an academic institution. Thirty-nine of 268 patients were octogenarians with a mean (± SD) age of 83.4 ± 3.4 years, and 25 were men. Kaplan-Meier survival and Fisher's post hoc statistical analyses were performed.
  
  
  RESULTS
  Thirty-seven octogenarian patients selected HD and two selected peritoneal dialysis. Among the 37 HD patients, 29 initiated dialysis with a tunneled cuffed catheter, 6 with an arteriovenous fistula, and 2 with an arteriovenous graft. Three patients regained renal function after an average 112 days and one was lost to follow-up. Of the 33 remaining on HD, 8 required nursing home admission and 25 were discharged home after initiating HD. Among these 33, 19 died and 14 remained on HD at the end of study period. Days on dialysis (mean ± SEM) before death in those discharged to a nursing facility versus home were 52.6 ± 14.7 versus 386.1 ± 90.7 (P < 0.05), respectively.
  
  
  CONCLUSIONS
  Vascular access planning should include assessment of functional status and life expectancy in octogenarian HD patients.
authors.affiliation: Dialysis Access Group of Wake Forest University, Department of Internal Medicine/Nephrology and Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. tvachhar@wfubmc.edu
authors.forename: Tushar J
authors.initials: TJ
authors.lastname: Vachharajani
authors.forename: Shahriar
authors.initials: S
authors.lastname: Moossavi
authors.forename: Jean R
authors.initials: JR
authors.lastname: Jordan
authors.forename: Vidula
authors.initials: V
authors.lastname: Vachharajani
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
authors.forename: John M
authors.initials: JM
authors.lastname: Burkart
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality; D002405:Catheterization, Central Venous; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006299:Health Services for the Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008017:Life Expectancy; D008297:Male; D009657:North Carolina; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome