Arteriovenous fistula outcomes in the elderly.
OBJECTIVE
Over several decades, there has been an increase in the number of elderly patients requiring hemodialysis. These older patients typically have an increased incidence of comorbidities including diabetes, hypertension, and peripheral vascular disease. We undertook a systematic review of the current literature to assess outcomes of arteriovenous fistula (AVF) formation in the elderly and to compare the results of radiocephalic AVFs vs brachiocephalic AVFs in older patients.


METHODS
A literature search was performed using MEDLINE, Embase, PubMed, and the Cochrane Library. All retrieved articles published before December 31, 2014 (and in English) primarily describing the creation of hemodialysis vascular access for elderly patients were considered for inclusion. We report pooled AVF patency rates and a comparison of radiocephalic vs brachiocephalic AVF patency rates using odds ratios (ORs).


RESULTS
Of 199 relevant articles reviewed, 15 were deemed eligible for the review. The pooled 12-month primary and secondary AVF patency rates were 53.6% (95% confidence interval [CI], 47.3-59.9) and 71.6% (95% CI, 59.2-82.7), respectively. Comparison of radiocephalic vs brachiocephalic AVF patency rates demonstrated that radiocephalic AVFs have inferior primary (OR, 0.72; 95% CI, 0.55-0.93; P = .01) and secondary (OR, 0.76; 95% CI, 0.58-1.00; P = .05) patency rates.


CONCLUSIONS
This meta-analysis confirms that adequate 12-month primary and secondary AVF patency rates can be achieved in elderly patients. Brachiocephalic AVFs have both superior primary and secondary patency rates at 12 months compared with radiocephalic AVFs. These important data can inform clinicians' and patients' decision-making about suitability of attempting AVF formation in older persons.
Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom. Electronic address: damianmcg@gmail.com.
Damian
D
McGrogan
Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom; ReDVA Research Consortium, Dundee, United Kingdom.
Julien
J
Al Shakarchi
Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom; ReDVA Research Consortium, Dundee, United Kingdom.
Aurangzaib
A
Khawaja
Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Jay
J
Nath
Department of Statistics, Wolfson Computer Laboratory, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.
James
J
Hodson
Department of Nephrology, Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom.
Alexander P
AP
Maxwell
Department of Renal Surgery, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom; ReDVA Research Consortium, Dundee, United Kingdom.
Nicholas G
NG
Inston
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D001916:Brachial Artery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D017534:Radial Artery; D006435:Renal Dialysis; D016896:Treatment Outcome; D014654:Vascular Patency