Hemodialysis access creation in elderly patients: Strategic options

Abstract

Background: All guidelines recommend the importance of an effective vascular access for successful hemodialysis, emphasizing the recommendation of using autologous arteriovenous fistulas (AVFs) due to their favorable long-term patency and low complication rates. However, the decline in AVF usage is noted, attributed to demographic changes in the dialysis population, including an increase in very old patients with multiple comorbidities.

Methods: We explore the results and performance of various vascular access types (AVF, arteriovenous graft, central vein catheter) in relation to late referral and patient demographics. We also discuss patient morbidity and mortality in relation to the chosen access type.

Conclusion: The high risk of non-maturing autologous AVFs in elderly patients may justify the use of early stick grafts, and high-risk patients might benefit from permanent central vein catheters.

Keywords: Hemodialysis; arteriovenous fistula; arteriovenous graft; central vein catheter; elderly patients; vascular access.