Introduction:
Elderly patients are a rising demographic around the world and are usually affected by numerous comorbidities like Diabetes, Coronary Artery Disease(CAD), etc. The optimal dialysis access for elderly patients remains a challenge due to difficult balance between risks and benefits in a population with increased comorbidity and decreased survival. Increased age has been associated with non-maturing fistula with more than doubling of the risk in those aged >65 years. 1 year patency rates ranged from 43-79%. Studies have shown an association between geriatric syndromes such as frailty , dementia and Vascular access dysfunction. Some centres hence proposed the use of tunnelled cuffed catheter as primary access in frail elderly patients avoiding the use of an arteriovenous access. This study aimed to determine the 1-year patency of vascular access in elderly and its association with frailty.
Methods:
This is a prospective observational study done in Sri Ramachandra University, Chennai over a period of one year. 86 Elderly patients ( >65 years ) who were initiated on long term Hemodialysis (HD) through arteriovenous fistula (AVF) were studied. Primary and secondary patency of the access was noted along with frailty score, laboratory parameters and outcomes (AVF and Patient). Frailty was assessed according to CFS (Clinical frailty score).
Results:
Out of the 86 patients, 72% were male, 63% were diabetic. 58 patients (67%) had CFS between 1-5 and 28 (33%) had more severe degree of frailty with score of 6-9. At the end of 1 year, Primary Patency was 83% (72 of 86) in this study population. It was noted that although the primary patency rate was lower at higher CFS scores (75% vs 87%), the difference was not significant( p-0.211). Even the group with moderate and severe frailty had primary patency of 75% of their first AV access at one year. Out of the Laboratory parameters , only higher serum creatinine at initiation was associated with lower primary patency.
Conclusions:
The reported prevalence of frailty in patients with HD varies widely, ranging from 21% to 73%. In our study, higher degrees of Frailty does not preclude the placement of AV Access. Primary patency at the end of one year did not correlate with biochemical values like calcium, phosphorous, albumin nor comorbidities like Diabetes or CAD. Late initiation of HD with higher creatinine was associated with greater risks of Access failure. Further research should focus on the interventions for frailty to optimize the process of caring for dialysis vascular access in elderly.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.