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Elderly hemodialysis patients: AVF improves outcomes

For elderly patients, the optimal type of initial permanent access for hemodialysis is still very much up for discussion, say researchers at the University of Alabama in Birmingham (US) (Lee T et al, Vascular Access Type and Clinical Outcomes among Elderly Patients on Hemodialysis.

Clin J Am Soc Nephro 2017;12:1823-1830). In general, treating physicians consider factors such as duration of central venous catheter (CVC) dependence, patient comorbidities, and life expectancy when deciding on whether to place an arteriovenous fistula (AVF) or graft (AVG). In the present study, the authors decided to compare the clinical outcomes in two groups of elderly patients. All of the patients in the study had initiated hemodialysis with a CVC, but subsequently either an AVF (n= 7,433) or an AVG (n= 2,025) was placed. AVF patients fared better: They were less likely to be hospitalized and also had a lower risk of death.

In total, 9,458 patients aged ≥ 67 years were enrolled. AVF patients had a greater CVC dependence in the six months after placement than AVG patients; however, they also had lower rates of all-cause infection-related and bacteremia/septicemia-related hospitalization (adjusted relative risk, 0.93 and 0.90, respectively) as well as a lower adjusted risk of death (hazard ratio, 0.76).

Elderly patients initiating hemodialysis with a CVC who underwent AVF placement within six months had an extended CVC dependence, but despite this dependence they also had fewer hospitalizations due to infections and a lower likelihood of death than AVG patients.

Link to the study: http://cjasn.asnjournals.org/content/12/11/1823.abstract