Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Division of Research, Singapore General Hospital, Singapore, Singapore.
Int Urol Nephrol. 2021 Sep;53(9):1923-1931. doi: 10.1007/s11255-021-02822-w. Epub 2021 Mar 6.
The optimal vascular access strategy in elderly patients receiving haemodialysis (HD) remains controversial. We aim to report the outcomes of arteriovenous fistula (AVF) in elderly patients initiated on maintenance HD in our centre.
Medical records of 688 incident patients initiated on HD from 2010 to 2012 in a tertiary centre were retrospectively reviewed. Patients' characteristics and AVF outcomes were compared among those < 65 years (non-elderly), ≥ 65-75 years (early elderly) and ≥ 75 years (late elderly).
There were 418 non-elderly, 184 early elderly and 86 late elderly patients. There is a higher proportion of brachiocephalic and brachiobasilic fistula created in the late elderly (24.9% vs. 37.0% vs. 41.8%, p = 0.001). The outcomes of accesses created were comparable in the 3 age groups with similar proportions of functional AVFs (80.4% vs. 79.3% vs. 75.6%, p = 0.832) and comparable 1-, 3- and 5-year primary and secondary patency rates (p = 0.351 and 0.282, respectively). However, a longer maturation time (2.78 vs. 2.86 vs. 3.72 months, p = 0.010) and a higher mean number of interventions to assist maturation of the first AVF were required in late elderly patients (0.19 vs. 0.22 vs. 0.35, p = 0.014). Following AVF creation, median patient survival in the non-elderly, early and late elderly was 65.2 vs. 55.1 vs. 49.8 months respectively.
AVFs created in elderly patients have comparable outcomes compared to non-elderly patients although more interventions are required to assist maturation with a longer maturation time necessitating early access creation to allow for time needed due to maturation delay.
在接受血液透析（HD）的老年患者中，最佳的血管通路策略仍存在争议。我们旨在报告我们中心接受维持性 HD 的老年患者动静脉瘘（AVF）的结果。
回顾性分析了 2010 年至 2012 年在一家三级中心接受 HD 的 688 例首发患者的病历。比较了<65 岁（非老年）、≥65-75 岁（早老年）和≥75 岁（晚老年）患者的特征和 AVF 结果。
共有 418 名非老年患者、184 名早老年患者和 86 名晚老年患者。晚老年患者中创建头臂静脉和头臂静脉掌浅弓瘘的比例较高（24.9%比 37.0%比 41.8%，p=0.001）。3 个年龄组创建的通路结果相似，功能 AVF 的比例相似（80.4%比 79.3%比 75.6%，p=0.832），1、3 和 5 年的主要和次要通畅率也相似（p=0.351 和 0.282）。然而，晚老年患者需要更长的成熟时间（2.78 比 2.86 比 3.72 个月，p=0.010），并且需要更多的干预措施来帮助成熟第一个 AVF（0.19 比 0.22 比 0.35，p=0.014）。AVF 建立后，非老年、早老年和晚老年患者的中位生存时间分别为 65.2、55.1 和 49.8 个月。
尽管需要更多的干预措施来帮助成熟，并且由于成熟延迟需要提前创建通路以留出所需的时间，因此成熟时间较长，但在老年患者中创建的 AVF 与非老年患者的结果相似。
