#3408 A META-ANALYSIS OF VASCULAR ACCESS OUTCOMES IN HEMODIALYSIS PATIENTS OVER 75 YEARS OF AGE

Abstract

Abstract Background and Aims The age of patients with end-stage renal disease is constantly growing, but evidence for the best vascular access for hemodialysis is scarce and controversial for elderly. A meta-analysis was performed in hemodialysis patients over 75 years old to compare the outcomes of different vascular access procedures in the sub-group of elderly ESRD patients ≥ 75 years of age. Method A literature search was performed using the electronic databases MEDLINE and SCOPUS up to October 2021. Twelve eligible articles fulfilled the inclusion criteria and were finally selected in the meta-analysis (Table). Three of these studies including ESRD patients >70 years of age were exceptionally included as the mean age was well above 75 years. First step analysis was focused on studies that reported the primary patency rates of autologous vs. prosthetic vascular accesses (5 studies). Second step analysis was focused on articles comparing the results of primary and secondary patency rates of distal (forearm) vs. proximal (upper arm) fistulas in elderly patients (8 studies). All these studies were retrospective cohort studies, none was randomized controlled trial. Results Regarding the first step analysis, primary failure rate at 24 months was in favor of AVFs (OR: 0.56, 95% CI: 0.38-0.83, p = 0.003, Fig. 1). Although several studies have shown that AVG patency is not affected by age, this meta-analysis showed patency benefit of AVF in this subgroup of elderly patients ≥75 years of age. In a second step, the 12-month primary failure rate was by far in favor of proximal AVFs (OR: 2.14, 95% CI: 1.53-2.97; p<.00001, Fig. 2). The 12-month secondary patency rate of the forearm AVFs was also inferior compared to the proximal AVF (OR: 1.76, 95% CI: 1.12-2.78; p<.01, Fig. 3) These findings favor the use of proximal AVFs as first choice access in this subgroup of elderly patients, especially when they are late referrals or have low life expectancy. Conclusion The question of the right access in elderly ESRD patients does not have an easy answer. The present study shows that patients ≥75 years old should not be excluded from creation of an autologous access, with proximal AVFs having better patency rates.