title: Vascular access in older patients: an Italian survey.
abstract: BACKGROUND
  The number of older patients starting  hemodialysis is continuously increasing. The type of vascular access plays an important role in dialysis treatment, but it can be difficult to create in older patients.
  
  
  METHODS
  This study compared vascular access survival rates and patient survival rates in older (≥65 years) and younger (<65 years) patients starting hemodialysis in 2 Italian hospitals in 2006-2008.
  
  
  RESULTS
  The study enrolled 336 patients: 208 ≥65 years and 128 <65 years of age. The vascular accesses used, in order of frequency, were 102 distal arteriovenous fistulas (dAVFs) (49%), 55 midarm AVFs (pAVFs) (26%), 9 arteriovenous grafts (AVGs) (4%) and 42 central venous catheters (CVCs) (20%) in the older patients, and 89 dAVFs (69%), 25 pAVFs (19%), 6 AVGs (5%) and 8 CVCs (6%) in the younger patients. Survival rates of fistula and catheter did not differ between the 2 groups. AVGs failed earlier (p = 0.02) in the older patients. On Cox analysis, age (hazard ratio [HR] = 1.073; p<0.001) and CVC (HR = 4.152; p<0.001) increased the risk of death.
  
  
  CONCLUSIONS
  A fistula is the gold standard for hemodialysis vascular access in older patients if judged appropriately.
authors.affiliation: Division of Nephrology, Ospedale "S.Chiara", APSS, Trento - Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Venturelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Bandera
authors.forename: Roberto
authors.initials: R
authors.lastname: Zubani
authors.forename: Ezio
authors.initials: E
authors.lastname: Movilli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Veniero
authors.forename: Mario
authors.initials: M
authors.lastname: Gaggiotti
authors.forename: Gina
authors.initials: G
authors.lastname: Gregorini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Brunori
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate