title: Arteriovenous fistula for the 80 years and older patients on hemodialysis: is it worth it?
abstract: Over the last years, the proportion of patients older than 80 years with end-stage renal disease has been constantly growing. Arteriovenous fistula (AVF) is known as the best vascular access for hemodialysis, but evidence for its added value is lacking for elderly. We retrospectively identified new vascular access (AVF and central venous catheter) created or installed between June 2005 and June 2008 in patients 80 years and older and in patients between 50 and 60 years. For every new AVF, we calculated primary failure, primary and secondary patency durations. Fifty-five and 57 patients had a new vascular access in the >80 years old and 50 to 60 years old groups. Among these, 25 and 41 were new AVF in the older and younger groups. Primary failure was more frequent in elderly than in the younger (40% vs. 17%, P=0.04). Primary patency was not significantly different in both groups (P=0.06). Secondary patency was shorter in elderly (P=0.005). Among the older group, the presence of an AVF was not associated with a difference in mortality (46% vs. 60%, P=0.28), whereas there was a lower mortality in the younger group with AVF (12% vs. 43% P=0.008). These results indicate lower patency duration in very elderly patients compared to middle-aged patients. Without leading to the exclusion of patients over 80 years old for AVF creation, it might reinforce the need of a careful selection and evaluation in this population prior to referral.
authors: Nephrology, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
authors: Annie-Claire
authors: AC
authors: Nadeau-Fredette
authors: Rémi
authors: R
authors: Goupil
authors: Bernard
authors: B
authors: Montreuil
authors: Annie
authors: A
authors: Carignan
authors: Martine
authors: M
authors: Leblanc
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000209:etiology*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Arteriovenous fistula; and secondary patency; elderly; hemodialysis; primary; vascular access