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- Title
Arteriovenous fistula outcomes in the era of the elderly dialysis population.
- Authors
Lok, Charmaine E.; Oliver, Matthew J.; Su, Jiandong; Bhola, Cynthia; Hannigan, Neil; Jassal, Sarbjit V.
- Abstract
Arteriovenous fistula outcomes in the era of the elderly dialysis population.Background.The growth of patients≥65 years on hemodialysis is increasing. Guidelines recommend arteriovenous fistula (AVF) access but their outcomes in elderly patients are controversial. This study compared the outcomes of AVF in patients<65 years old (65− group) versus those≥65 years old (65+ group).Methods.This retrospective analysis of prospectively collected data included 444 incident, first-time AVF created in a large dialysis center between January 1, 1995 and July 1, 2003. The primary outcome of AVF cumulative patency was evaluated using Kaplan-Meier survival analysis with log-rank test comparison. A Cox model determined factors associated with AVF loss.Results.One hundred ninety-six patients (44%) were in the 65+ group. In total, there were 230 (52.2%) radiocephalic, 186 (42.2%) brachiocephalic, and 25 (5.6%) basilic vein transposed AVF. The one-year AVF cumulative survival was 75.1% (65+ group) and 79.7% (65− group); the five-year survival was 64.7% (65+ group) and 71.4% (65− group). The overall total procedure, angioplasty, thrombolysis, and revision rates per access-year were 0.83, 0.30, 0.66, and 0.16, respectively. The 65+ group had a relative risk of 1.7 of their AVF failing to mature compared with the 65− group. Multivariate analysis yielded these variables significant for AVF loss: male sex HR 0.63 (95% CI 0.44–0.91), coronary artery disease HR 2.1 (95% CI 1.5–3.0), and Caucasian ethnicity HR 0.63 (95% CI 0.44–0.91).Conclusion.Age should not be a limiting factor when determining candidacy for AVF creation due to equivalent survival and procedural rates. Failure of fistula maturation is a primary concern to patients of all ages and demands further study.
- Subjects
DIALYSIS (Chemistry); ARTERIOVENOUS fistula; BLOOD-vessel abnormalities; DIFFUSION; OSMOSIS; PLASTIC surgery; RELATIVE medical risk; CONFIDENCE intervals; LOG-rank test; MULTIVARIATE analysis; HEALTH outcome assessment; RETROSPECTIVE studies; ACQUISITION of data; MEDICAL records; KAPLAN-Meier estimator; DESCRIPTIVE statistics; LONGITUDINAL method; PROPORTIONAL hazards models; ANGIOPLASTY; OLD age
- Publication
Kidney International, 2005, Vol 67, Issue 6, p2462
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1111/j.1523-1755.2005.00355.x