Gold standard dialysis procedure may not be so golden for elderly patients

Elderly patients with kidney failure may not gain the same benefits from what's considered the gold standard for accessing the blood for dialysis compared with younger patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that vascular access procedures should be tailored to individual dialysis patients in the elderly population.

The elderly represent the most rapidly growing group of patients on dialysis for kidney failure. Research clearly shows an arteriovenous fistula, which is created by connecting a patient's own vein and artery to form a long-lasting site through which blood can be removed and returned, is the best way to gain access to the blood for dialysis in younger individuals. Other types of access involve the use of a catheter, which does not require needle sticks, and arteriovenous , which is a plastic conduit between an artery and a vein. It's currently unclear which of these is the best type of dialysis access for elderly patients.

To investigate, Ranil DeSilva, MD, Alexander Goldfarb-Rumyantzev, MD, PhD (Beth Israel Deaconess Medical Center), and their colleagues studied information from 2005 to 2008 on more than 115,000 over 66 years of age, 35% of whom were in their 80s and 90s.

Among the major findings over four years:

  • The use of was linked with more than a 74% increased risk of death in patients of any age.
  • While use of an improved survival compared with use of an arteriovenous graft in patients in their late 60s and 70s, patients in their 80s and 90s experienced similar survival rates with the two procedures.

The findings suggest that in patients who are older than 80 years, placing a graft—which takes a much shorter time to establish and can be placed shortly before starting dialysis—may be a reasonable alternative to a fistula. This is particularly true for those with small veins or when it is uncertain when may be needed.

"In an era using more standardized quality outcome measures, we must remain cautious about generalizing measures to our growing elderly population. In the case of our study, a strategy that is clearly superior in young individuals requiring hemodialysis for does not appear to be the clearly superior strategy for elderly individuals," said Dr. DeSilva. "It appears that the optimal vascular access choice should be tailored to the specific patient in the ," he added.

In an accompanying editorial, Ann O'Hare, MD (University of Washington, Seattle) stressed that "to deliver care that is truly centered on the patient, we may ultimately need to set aside traditional metrics focusing on universal treatment targets… in favor of new ones focusing on the extent to which the process and outcomes of access selection support the goals and preferences of individual patients."

add to favorites email to friend print save as pdf

Related Stories

Frequent dialysis poses risks for kidney disease patients

Feb 07, 2013

Compared with standard dialysis, frequent dialysis can cause complications related to repeated access to the blood, requiring patients to undergo more repair procedures to the site through which blood is removed and returned, ...

Recommended for you

Recorded Ebola deaths top 7,000

8 hours ago

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

12 hours ago

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

Dec 19, 2014

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

Dec 19, 2014

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.