Vascular access for elderly hemodialysis patients: what should we aim for?

Abstract

Elderly chronic kidney disease (CKD) patients are one of the fastest growing groups in hemodialysis (HD). However, overall mortality and arteriovenous fistulae failure are still high in this population. Therefore, a different vascular access policy may be advised for this group of patients. We searched PubMed for relevant articles published in English between the years 2000-2015. Studies investigating vascular access-related outcomes in elderly CKD patients were included. The scarce literature on this topic suggests that elderly CKD patients are more likely to undergo unnecessary vascular access procedures. However, with appropriate vascular evaluation, arteriovenous access placement is a viable strategy for this group of patients and dialysis access-related outcomes are superior for arteriovenous access in comparison with dialysis catheters. When deciding whether or not to create an arteriovenous vascular access in elderly CKD patients, physicians should consider the probability of CKD progression, the expected life expectancy and quality of life of the patient and the probability of success of an arteriovenous access creation.