Centre of Public Health, Queen's University, Belfast, UK.
Regional Nephrology & Transplant Unit, Belfast Health and Social Care Trust, Belfast, UK.
J Vasc Access. 2024 Jul;25(4):1093-1099. doi: 10.1177/11297298221147571. Epub 2023 Jan 6.
The optimal vascular access in the elderly remains contentious in the context of increasingly limited resources and anticipated survival on hemodialysis. Research focus has shifted to include the impact of vascular access on quality of life. This study explored clinical outcomes in individuals aged ⩾75 years who had an arteriovenous fistula (AVF) created in a single center over a 10-year period.
Demographic and clinical data concerning AVFs created January 2009-December 2019 were identified from a prospective database for retrospective analysis. Outcome measures were AVF patency and failure to mature rates plus overall patient and vascular access survival. The Vascular Access Specific Quality of life measure (VASQoL) was completed in a contemporary cohort aged ⩾75 years established on HD in October 2021.
AVF outcomes were available for 272 patients (93%). The failure to mature (FTM) rate was 36% with the significant predictors of AVF FTM being the creation of a radiocephalic AVF (OR 8.13, 95% CI 8.02-8.52, < 0.01), female gender (OR 4.84, 95% CI 4.70-5.41, < 0.01), and a history of peripheral vascular disease (OR 5.25, 95% CI 5.22-6.00, value = 0.02). Functional patency was associated with a median 12-month survival benefit compared to those whose fistula FTM ( < 0.01). The median patency duration for a functionally patent AVF was 3 years. Elderly patients with a fistula reported a lower quality of life in VASQoL scoring than those with central venous catheters.
In this cohort, AVF creation in individuals aged ⩾75 years AVFs was associated with comparable AVF patency rates to younger patients. AVF functional patency was associated with superior patient survival compared to those with AVF FTM. A multi-disciplinary surveillance program may help reduce AVF loss. Further work on how vascular access choice impacts quality of life in elderly patients is required.
在资源日益有限且预期在血液透析中生存的情况下，老年人的最佳血管通路仍存在争议。研究重点已转移到包括血管通路对生活质量的影响。本研究探讨了在一个中心在 10 年内创建动静脉瘘 (AVF) 的 ⩾75 岁个体的临床结果。
从前瞻性数据库中确定了 2009 年 1 月至 2019 年 12 月创建的 AVF 的人口统计学和临床数据，以进行回顾性分析。结果测量指标是 AVF 通畅率和不成熟失败率以及总体患者和血管通路生存率。血管通路特定生活质量测量 (VASQoL) 是在 2021 年 10 月建立的当代 ⩾75 岁接受 HD 的患者队列中完成的。
272 名患者（93%）的 AVF 结果可用。不成熟失败率 (FTM) 为 36%，AVF FTM 的显著预测因素是创建头静脉动静脉瘘（OR 8.13，95%CI 8.02-8.52，<0.01），女性（OR 4.84，95%CI 4.70-5.41，<0.01）和外周血管疾病史（OR 5.25，95%CI 5.22-6.00，值=0.02）。与瘘管 FTM 的患者相比，功能通畅的患者在 12 个月时具有更高的生存获益（<0.01）。功能通畅的 AVF 的中位通畅时间为 3 年。瘘管患者的生活质量评分 VASQoL 比中央静脉导管患者低。
在本队列中， ⩾75 岁患者的 AVF 形成与年轻患者的 AVF 通畅率相当。与 AVF FTM 患者相比，AVF 功能通畅与患者生存获益更高相关。多学科监测计划可能有助于减少 AVF 丢失。需要进一步研究血管通路选择如何影响老年患者的生活质量。
