Hemodialysis arteriovenous fistula as first option not necessary in elderly patients

Journal of Vascular Surgery
Jie CuiZubin Irani

Abstract

Kidney Disease Outcomes Quality Initiative guidelines recommend arteriovenous fistulas as the preferred access for hemodialysis patients. However, this may not hold across all populations of patients, especially the elderly, given their comorbidities and relatively reduced life expectancy. Therefore, we investigated whether fistulas held benefit over arteriovenous grafts as hemodialysis access in elderly patients. We retrospectively searched a vascular access database to compare the outcomes for 138 fistulas and 44 grafts that were placed in elderly patients (≥75 years old) during a 4-year period at a tertiary medical center. The primary failure rate was higher for the fistulas compared with the grafts (odds ratio, 2.89; P = .008), and more fistulas required one or more interventions before their successful use compared with grafts (31% vs 10%, respectively; P = .03). In addition, the time to catheter-free dialysis was longer for fistulas than for grafts (P < .001). However, the primary and secondary patency rates were comparable between the fistulas and grafts and between the different access locations. The all-cause mortality rates were also comparable between the fistula and graft groups. Despite the Fistula First Initiative...Continue Reading

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Citations

Apr 21, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Charmaine E LokMichael J Choi
Apr 23, 2019·The Journal of Vascular Access·Nathan K ItogaMatthew W Mell
Jul 13, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Karen Woo, Charmaine E Lok
Apr 21, 2020·The Korean Journal of Thoracic and Cardiovascular Surgery·Joung Woo SonSung Wook Chang
Mar 24, 2017·Vascular and Endovascular Surgery·Jacques GreenbergEric T Choi
Nov 23, 2019·BMC Nephrology·Seonjeong JeongYong-Pil Cho
Jan 27, 2019·Journal of Vascular Surgery·Isibor J ArhuideseMahmoud B Malas
Feb 15, 2021·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Beini LyuBrad C Astor
Mar 7, 2021·International Urology and Nephrology·Peiyun LiuChieh Suai Tan
Mar 13, 2021·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Anna LimaAna Germano
Dec 29, 2018·Journal of Vascular Surgery·Thomas W ChengJeffrey J Siracuse
Jul 24, 2021·Journal of Vascular Surgery·Isibor J ArhuideseMahmoud B Malas

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