A meta-analysis of dialysis access outcome in elderly patients

J Vasc Surg. 2007 Feb;45(2):420-426. doi: 10.1016/j.jvs.2006.10.035.


Background: Many authors report inferior patency rates of distal arteriovenous fistulas in elderly patients and others present contradictory results. A meta-analysis of available evidence was performed to assess (1) whether non-elderly adults have the same risk of forearm arteriovenous fistula failure as elderly patients with end-stage renal disease and (2) whether such a distal access has the same risk of failure as more proximal access procedures or grafts in elderly patients.

Methods: A literature search was performed using the MEDLINE and SCOPUS electronic databases. The analysis involved studies that comprised subgroups of elderly patients and compared their outcomes with those of non-elderly adults. Articles comparing patency rates of radial-cephalic and proximal fistulas or grafts in elderly patients were also included. Thirteen relevant studies (all cohort observational studies, 11 retrospective) were identified and included in the final analysis.

Results: The meta-analysis revealed a statistically significantly higher rate of radial-cephalic arteriovenous fistula failure in elderly patients compared with non-elderly adults at 12 (odds ratio [OR], 1.525; P = .001) and 24 months (OR, 1.357, P = .019). The primary radial-cephalic arteriovenous fistula failure rate was also in favor of the non-elderly adults (OR, 1.79; P = .012). Secondary analysis revealed a pooled effect in favor of the elbow brachiocephalic fistulas that was statistically significant (P = .004) compared with distal fistulas in elderly patients.

Conclusion: This meta-analysis found an increased risk of radial-cephalic fistula failure in elderly patients and significant benefit from the creation of proximal autologous brachiocephalic fistulas. If confirmed by further prospective studies, these differences should be considered when planning a vascular access in incident elderly patients.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Age Factors
  • Aged
  • Arteriovenous Shunt, Surgical*
  • Blood Vessel Prosthesis Implantation*
  • Forearm / blood supply*
  • Humans
  • Kidney Failure, Chronic / physiopathology
  • Kidney Failure, Chronic / therapy*
  • Middle Aged
  • Odds Ratio
  • Renal Dialysis / methods*
  • Risk Factors
  • Time Factors
  • Treatment Failure
  • Vascular Patency*