title: The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology.
abstract: The incident hemodialysis (HD) population is aging, and the elderly group is the one with the most rapid increase. In this context it is important to define the factors associated with outcomes in elderly patients. The high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and congestive heart failure, usually make vascular access (VA) creation more difficult. Furthermore, many of these patients may have an insufficient vasculature for fistula maturation. Finally, many fistulas may never be used due to the competing risk of death before dialysis initiation. In these cases, an arteriovenous graft and in some cases a central venous catheter become a valid alternative form of VA. Nephrologists need to know what is the most appropriate VA option in these patients. Age should not be a limiting factor when determining candidacy for arteriovenous fistula creation. The aim of this position statement, prepared by experts of the Vascular Access Working Group of the Italian Society of Nephrology, is to critically review the current evidence on VA in elderly HD patients. To this end, relevant clinical studies and recent guidelines on VA are reviewed and commented. The main advantages and potential drawbacks of the different VA modalities in the elderly patients are discussed.
authors.affiliation: U.O.C. di Nefrologia e Dialisi, Ente Ecclesiastico Ospedale "F.Miulli", 70021, Acquaviva delle Fonti, Italy. carlolomonte@libero.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lomonte
authors.affiliation: Struttura Complessa a Direzione Universitaria di Nefrologia e Dialisi, Ospedale Giovanni Bosco, Turin, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Forneris
authors.affiliation: Unità di Nefrologia e Dialisi, Ospedale San Carlo, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.affiliation: Dipartimento di Scienze Chirurgiche, Policlinico Gemelli, Università Cattolica Sacro Cuore, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tazza
authors.affiliation: Dipartimento di Medicina, Università di Pisa, Pisa, Italy.|Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Meola
authors.affiliation: Unità di Nefrologia e Dialisi, Ospedale Santo Spirito, Pescara, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lodi
authors.affiliation: U.O.C. di Nefrologia e Dialisi, Ospedale Annunziata, Cosenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Senatore
authors.affiliation: Unità di Nefrologia e Dialisi, A.O. Cannizzaro, Catania, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Morale
authors.affiliation: Unità di Nefrologia e Dialisi, Ospedale San Gavino Monreale, Cagliari, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Spina
authors.affiliation: U.O.C. di Nefrologia e Dialisi, Ospedale Santa Caterina Novella, Galatina, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Napoli
authors.affiliation: Unità di Nefrologia e Dialisi, Ospedale di Carpi, Carpi, Italy.
authors.forename: Decenzio
authors.initials: D
authors.lastname: Bonucchi
authors.affiliation: Unità di Nefrologia IRCCS, Fondazione Salvatore Maugeri, Pavia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Galli
mesh_terms: D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000592:standards*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000592:standards*; D015897:Comorbidity; D032921:Consensus; D018450:Disease Progression; D006801:Humans; D007558:Italy; D009398:Nephrology / Q000592:standards*; D018579:Patient Selection; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D012955:Societies, Medical / Q000592:standards*; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Arteriovenous fistula; Arteriovenous graft; Central venous catheter; Elderly; Vascular access