Optimal Hemodialysis Vascular Access in the Elderly Patient

Louise M. Moist, Charmaine E. Lok, Tushar J. Vachharajani, Wang Xi, Ahmed Aljaishi, Kevan R. Polkinghorne, Miguel Vazquez, Timmy C. Lee

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

The optimal vascular access for elderly patients remains a challenge due to the difficulty balancing the benefits and risks in a population with increased comorbidity and decreased survival. Age is commonly associated with failure to mature in fistula and decreased rates of primary and secondary patency in both fistula and grafts. In the elderly, at 1 and 2years, primary patency rates range from 43% to 74% and from 29% to 67%, respectively. Secondary patency rates at 1 and 2years range from 56% to 82% and 44% to 67%, respectively. Cumulative fistula survival is no better than grafts survival when primary failures are included. Several observational studies consistently demonstrate a lower adjusted mortality among those using a fistula compared with a catheter; however, catheter use in the elderly is increasing in most countries with the exception of Japan. Both guidelines and quality initiatives do not acknowledge the trade-offs involved in managing the elderly patients with multiple chronic conditions and limited life expectancy or the value that patients place on achieving these outcomes. The framework for choice of vascular access presented in this article considers: (1) likelihood of disease progression before death, (2) patient life expectancy, (3) risks and benefits by vascular access type, and (4) patient preference. Future studies evaluating the timing and type of vascular access with careful assessments of complications, functionality, cost benefit, and patients' preference will provide relevant information to individualize and optimize care to improve morbidity, mortality, and quality of life in the elderly patient.

Original languageEnglish (US)
Pages (from-to)640-648
Number of pages9
JournalSeminars in Dialysis
Volume25
Issue number6
DOIs
StatePublished - Nov 2012

Fingerprint

Blood Vessels
Renal Dialysis
Fistula
Patient Preference
Life Expectancy
Catheters
Survival
Mortality
Graft Survival
Cost-Benefit Analysis
Observational Studies
Disease Progression
Comorbidity
Japan
Quality of Life
Guidelines
Morbidity
Transplants
Population

ASJC Scopus subject areas

  • Nephrology

Cite this

Moist, L. M., Lok, C. E., Vachharajani, T. J., Xi, W., Aljaishi, A., Polkinghorne, K. R., ... Lee, T. C. (2012). Optimal Hemodialysis Vascular Access in the Elderly Patient. Seminars in Dialysis, 25(6), 640-648. https://doi.org/10.1111/sdi.12037

Optimal Hemodialysis Vascular Access in the Elderly Patient. / Moist, Louise M.; Lok, Charmaine E.; Vachharajani, Tushar J.; Xi, Wang; Aljaishi, Ahmed; Polkinghorne, Kevan R.; Vazquez, Miguel; Lee, Timmy C.

In: Seminars in Dialysis, Vol. 25, No. 6, 11.2012, p. 640-648.

Research output: Contribution to journalArticle

Moist, LM, Lok, CE, Vachharajani, TJ, Xi, W, Aljaishi, A, Polkinghorne, KR, Vazquez, M & Lee, TC 2012, 'Optimal Hemodialysis Vascular Access in the Elderly Patient', Seminars in Dialysis, vol. 25, no. 6, pp. 640-648. https://doi.org/10.1111/sdi.12037
Moist LM, Lok CE, Vachharajani TJ, Xi W, Aljaishi A, Polkinghorne KR et al. Optimal Hemodialysis Vascular Access in the Elderly Patient. Seminars in Dialysis. 2012 Nov;25(6):640-648. https://doi.org/10.1111/sdi.12037
Moist, Louise M. ; Lok, Charmaine E. ; Vachharajani, Tushar J. ; Xi, Wang ; Aljaishi, Ahmed ; Polkinghorne, Kevan R. ; Vazquez, Miguel ; Lee, Timmy C. / Optimal Hemodialysis Vascular Access in the Elderly Patient. In: Seminars in Dialysis. 2012 ; Vol. 25, No. 6. pp. 640-648.
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