Octogenarians and Nonoctogenarians Have Similar Outcomes after Upper Extremity Hemodialysis Access Creation

Abstract

Routine arteriovenous (AV) access creation in octogenarians is controversial. Our goal was to assess perioperative and long-term outcomes in octogenarians after undergoing upper extremity AV access to determine whether advanced age should influence AV access decision-making. All AV access creations performed at a single institution from 2014-2018 were retrospectively reviewed. Patients were categorized as octogenarians and nonoctogenarians. Perioperative short-term outcomes were compared. Among 620 patients who underwent AV access creation, there were 40 octogenarians and 580 nonoctogenarians. Octogenarians were more likely to have private insurance, coronary artery disease, dementia, previous stroke, impaired ambulation, and less likely to be current smokers. There were no differences in outpatient status or tunneled dialysis catheter presence at creation. Access types were similar radiocephalic (12.5% vs. 14.3%), brachiocephalic (50% vs. 42.6%), brachiobasilic (12.5% vs. 26.2%), and grafts (25% vs. 13.8%). Univariable analysis demonstrated no differences in perioperative return to the operating room, hematoma, and patency loss. There were no differences in 90-day mortality (OR 0.46, 95% CI 0-2.5, P=0.25), readmission (OR 1.36, 95% CI 0.67-2.76, P=0.39), maturation (OR 0.97, 95% CI 0.46-2.01, P=0.93), or reintervention (HR 0.9, 95% CI 0.64-1.25, P=0.53). Octogenarians had lower two-year survival (82.5% vs. 91.9%, P<0.001), but there was no difference in reintervention-free survival (55% vs. 47%, P=0.47) or occlusion-free survival (25% vs. 24%, P=0.62). Octogenarians and nonoctogenarians have similar outcomes after upper extremity dialysis access creation. Advanced age alone should not influence dialysis access creation.