Dialysis Procedure May Not Be Appropriate for Elderly

Elderly patients with kidney failure may not gain the same benefits from what’s considered the gold standard for accessing the blood for dialysis compared with younger patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology. The findings suggest that vascular access procedures should be tailored to individual dialysis patients in the elderly population.

The elderly represent the most rapidly growing group of patients on dialysis for kidney failure. Research clearly shows an arteriovenous fistula, which is created by connecting a patient’s own vein and artery to form a long-lasting site through which blood can be removed and returned, is the best way to gain access to the blood for dialysis in younger individuals. Other types of access involve using a catheter, which does not require needle sticks, and arteriovenous grafts, which are plastic conduits between an artery and a vein. It’s unclear which of these is the best type of dialysis access for elderly patients.

To investigate, Ranil DeSilva, MD, and Alexander Goldfarb-Rumyantzev, MD, PhD, of Beth Israel Deaconess Medical Center in Boston, and their colleagues studied information from 2005 to 2008 on more than 115,000 dialysis patients over the age of 66, 35% of whom were in their 80s and 90s.

Major findings over four years include the following:

• Catheter use was linked with more than a 74% increased risk of death in patients of any age.

• While using an arteriovenous fistula improved survival compared with using an arteriovenous graft in patients in their late 60s and 70s, patients in their 80s and 90s experienced similar survival rates with the two procedures.

The findings suggest that in patients who are older than the age of 80, placing a graft, which takes a much shorter time to establish and can be placed shortly before starting dialysis, may be a reasonable alternative to a fistula. This is particularly true for patients with small veins or in cases in which it’s uncertain when dialysis may be needed.

“In an era using more standardized quality outcome measures, we must remain cautious about generalizing measures to our growing elderly population. In the case of our study, a strategy that is clearly superior in young individuals requiring hemodialysis for kidney failure does not appear to be the clearly superior strategy for elderly individuals,” DeSilva says. “It appears that the optimal vascular access choice should be tailored to the specific patient in the elderly population.”

Source: American Society of Nephrology