Vascular access in super-aged patients

Purpose In developed countries, dialysis patients are aging along with the general population. The choice of vascular access (VA) is a more complex decision among elderly patients and is not specifically addressed by clinical practice guidelines. We investigated the relationship between the VA type at dialysis initiation in elderly patients and their prognosis, as well as the selection of the optimal VA type. Methods We conducted a retrospective observational cohort study of consecutive adult patients (age ≥18 years) as their first form of renal replacement therapy (RRT) between January 1, 2003, and December 31, 2010. For this study, VA included both arteriovenous fistula (AVF) and temporary central venous catheter (CVC). Results A total of 402 patients were included in this study. The percentage of patients who started dialysis with CVC increased with age, and 63% of those were over 80 years. The survival rate in the group of elderly patients (≥70 years) using CVC at dialysis initiation was significantly lower. In contrast, the survival rates were comparable between nonelderly patients (<70 years) using CVC or AVF. One hundred and thirty patients were super-aged (≥80 years). In super-aged patients (≥80 years) and aged patients (70-79 years), dialysis initiation with CVC was correlated with a significantly poorer survival rate than dialysis initiation with AVF. The survival rates were comparable between the low CRP group (<1.8 mg/dL) using CVC or AVF. Conclusions The initiation of dialysis with temporary CVC is not a risk factor of death in nonelderly patients (<70 years). On the other hand, in elderly (≥70 years) and super-aged (≥80 years) patients, dialysis initiation with CVC increased the risk of death, but they had to start dialysis with CVC on an emergency basis because of their clinical condition, that is, inflammations.