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Looking Beyond “Fistula First” in the Elderly on Hemodialysis
Author(s) -
Murea Mariana,
Satko Scott
Publication year - 2016
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12481
Subject(s) - medicine , hemodialysis , arteriovenous fistula , vascular access , dialysis , nephrology , catheter , intensive care medicine , quality of life (healthcare) , cardiology , surgery , nursing
Abstract Vascular access preparation, a pervasive challenge in hemodialysis ( HD ), is emerging as a multidimensional subject in geriatric nephrology. Previously published guidelines declared arteriovenous fistulas ( AVF ) as the preferred vascular access for all patients on HD . In this article, the benefit–risk evidence for using AVF versus an alternative access (arteriovenous graft [ AVG ] or tunneled central venous catheter [ TCVC ]) in the elderly is pondered. Compared to their younger counterparts, the elderly have significantly lower survival rates independent of the vascular access used for HD . Recent studies point to comparable dialysis survival rates between AVF and AVG or TCVC in subgroups of elderly patients, as well as lower rates of access‐related infections, and lower catheter dependence after AVG compared to AVF construction in these patients. Comprehensive and longitudinal assessments that integrate comorbidities, physical function, cognitive status, and quality of life to estimate prognosis and assist with vascular access selection ought to be employed. In circumstances where patient survival is limited by comorbidities and functional status, AVF is unlikely to confer meaningful benefits compared to AVG or even TCVC in the ill elderly.