Introduction: The outcome of arteriovenous fistula (AVF) for hemodialysis (HD) in elderly population remains an issue. The aim of our study was to evaluate the outcomes of arteriovenous fistulas created at our institute in patients older than 65 years.
Methods: All chronic HD patients with age >65 years who had an AVF created between January 1, 2010 and January 1, 2017 were included retrospectively. Baseline demographic information including age, gender, etiology of renal failure and comorbidities were recorded. Access characteristics including access type and anatomic location were recorded. The end point of study was primary and secondary patency. Minimum follow up period of study was 1 year.
Results: A total of 422 AVF were created within the study period. The mean age was 69.3 years. The anatomical site of AVF creation was radiocephalic (RCF) in 74.8% (n = 316), brachiocephalic (BCF) in 18.9% (n = 80) and brachiobasilic (BBF) in 6.1% (n = 26). At one year after creation, cumulative survival of the AVF was 64.7%. At 36 months the primary and secondary patency of RCF, BCF and BBF was 43.6%, 58.6%, 42.6% and 47.3%, 62.5%, 56.9% respectively. The overall median survival did not differ between RCF and BBF fistulas. However, when both were compared with BCF (median survival 1034 days), BBF (median survival 741 days) and RCF (median survival 592 days) had significantly poorer survival (P = 0.004). The most common reason for access failure was thrombosis (28.4%) followed by failure to mature (9%) and aneurysm related complications (9%).
Conclusions: Age should not be a limiting factor when choosing AVF as the preferred HD access. Brachiocephalic AVF has better primary and secondary patency with higher overall median survival. However RCF also provides reasonably good survival rates with acceptable complications in elderly population. Thrombosis and fistulas that fail to mature present as a primary concern to patients in elderly population, and demand further study.
Keywords: Arteriovenous fistula; elderly; hemodialysis; patency.
Copyright: © 2019 Indian Journal of Nephrology.
Conflict of interest statement
There are no conflicts of interest.
Brachiobasilic Fistulae: An Upper Limb Autologous Option for Everyone?H Hameed et al. Ren Fail 38 (4), 636-42. PMID 26923036.BBF are associated with a significant initial operative burden and higher complication and poorer patency rates than BCF. About one-third of BBF created in this series we …
Medicare Costs Associated With Arteriovenous Fistulas Among US Hemodialysis PatientsM Thamer et al. Am J Kidney Dis 72 (1), 10-18. PMID 29602630.AVF failure in the first year after creation is common and results in substantially higher health care costs. Compared with patients whose AVFs maintained primary patency …
Efficiency of the Kidney Disease Outcomes Quality Initiative Guidelines for Preemptive Vascular Access in an Academic SettingTA Kimball et al. J Vasc Surg 54 (3), 760-5; discussion 765-6. PMID 21703804.Despite successful creation and maturation of a preemptive AVF in nearly two-thirds of patients who started HD during the follow-up and given the following observations: …
Arteriovenous Fistula Outcomes in the ElderlyD McGrogan et al. J Vasc Surg 62 (6), 1652-7. PMID 26483002. - ReviewThis meta-analysis confirms that adequate 12-month primary and secondary AVF patency rates can be achieved in elderly patients. Brachiocephalic AVFs have both superior pr …
Gender Differences in Vascular Access in Hemodialysis Patients in the United States: Developing Strategies for Improving Access OutcomeRJ Marcus et al. Gend Med 4 (3), 193-204. PMID 18022587. - ReviewConcerns about smaller vascular diameters and reports of higher failure rates in women may prevent nephrologists and surgeons from considering AVF for female HD patients. …
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