Elder Patients - What is the Best Vascular Hemodialysis Access?

Abstract Background The incidence of end stage renal disease (ESRD) has increased in recent years. Elderly patients constitute the most rapidly growing group who need renal replacement therapy. In 2003, persons over 65 comprised 35% of all hemodialysed patients in Poland, and by the end of 2005 more than 44%. Methods From January 1984 through July 2004, patients 65 or older (n=133) starting hemodialysis (HD), were considered. The study group consisted of 80 men and 53 women (mean age 71.8±4.9 years). Patients-survival probability, primary, primary-assisted, and secondary patency of the vascular access (VA) were calculated using Kaplan-Mayer curves and log-rank analysis. Cox's proportional-hazards model was used to assess the influence of risk factors on VA patency. Results A total of 196 VAs were created. Of the 108 native arteriovenous fistulas (AVF) created, 24 were radiocephalic (RCAVF), 15 were brachiobasilic (BBAVF), and 64 were brachiocephalic (BCAVF). Arteriovenous grafts (AVG) were used in 35 patients and permanent tunneled cuffed catheters (PTCC) in 53. Secondary patency at 1-year was: 49% for native AVF, 62% for AVG, and 19% for PTCC. The survival rate of the 133 elderly patients was 63% at 1-year, 50% at 2 years, and 26% at 5 years. Conclusion People 65 and older are a predominant population in whom HD can preserve life. In elderly patients AVG had the best secondary patency. When limited life expectancy was taken into consideration AVGs were a good alternative for vascular access in hemodialysis.