Vascular access for elderly hemodialysis patients: what should we aim for?

Hemodialysis vascular access in elderly patients: A comprehensive review

The number of elderly patients initiating hemodialysis (HD) increased considerably over the past decade. Arteriovenous fistulas (AVFs) are the preferred vascular access (VA) type in most HD patients. Choice of VA for older hemodialysis patients presents a challenge. The higher incidence of comorbidities, longer AVF maturation times, risk of primary failure, risk of patency loss, and shorter life expectancy are important factors to consider. In this review we provide a comprehensive analysis on maturation rates, primary failure, patency, and mortality regarding vascular access in patients older than 75 years of age.

Outcome of Permanent Vascular Access with Vein ≤ 2.2 mm in Diameter

OBJECTIVE

End-stage renal disease patients with vein diameter of ≤2.2 mm can undergo autogenous arteriovenous fistula (AVF) formation with the acceptable results.

METHODS

This observational retrospective study of prospectively collected data analyzed end-stage renal disease patients with a vein diameter of ≤ 2.2 mm, who underwent AVF formation at Shifa International Hospital Islamabad from January 2009 to December 2017. The fistulae were observed for immediate success and maturity at 3 months. The chi-square test was used to determine the effect of vein diameter on final maturity. All data were analyzed using SPSS.

RESULTS

The total number of patients with vein diameter of ≤2.2 mm was 38, with a mean age of 46.76 ± 12.790 years. Vein diameters ranged from 1.6 to 2.2 mm. Immediate success was observed in 35 (92.1%) cases. Veins of 31 (81.6%) patients showing maturity at 3 months and were used for hemodialysis. The overall success rate for the small caliber veins was 82%.

CONCLUSION

Although end-stage renal disease patients present late with very small diameter veins, these veins should still be accommodated for permanent vascular access, because their maturity rates are still acceptable, even though these are lower than those of patients with adequate sized veins.