Introduction:
Vascular integrity in elderly population may affect maturation of Arterio-Venous fistula (AVF). Comparative vascular and biochemical factors between young and elderly responsible for AVF maturation were studied.
Methods:
It was a prospective observational study. CKD 4/5 patient age ≥ 18 years in whom AVF was indicated were included. They were divided in young (18-59 years) and elderly (≥ 60 years) groups. Various clinical, biochemical and radiological parameters were recorded. AVF was created after Doppler assisted vascular mapping. Clinical and doppler assessment like blood flow and wall shear stress (WSS) were done at 4th, 6th, and 12th weeks. At 4th and 6th week radiological maturation of AVF was defined as combination of blood flow of ≥500ml/min and diameter of 5 mm. At the end of 12 weeks association of biochemical factors with primary AVF failure were studied.
Results:
A total of 120 patients (60 in each age group) were included. Overall AVF maturation rate was 75% (n=90). Among elderly 70% (n=42) and younger 80% (n=48); p<0.02. Overall early clinical and radiological maturation were see in young as compared to elderly (p=0.022). Hyperphosphatemia, and higher c-reactive protein (CRP) levels were associated with AVF primary failure (p=0.033) and (p=0.005) respectively. Overall elderly patients had more arterial calcification (p=0.034). Radiocephalic AVF (RCAVF) was most common in both group 85% in young and 76.5% in elderly, however elderly patients were more likely to have brachiocephalic AVF (BCAVF) 14.8% and 23.3% respectively. Blood flow, fistula diameter, and WSS had significant differences between the matured and non-matured groups (p<0.001) in both young and elderly.
Conclusions:
Study showed higher primary AVF failure in elderly as compared to younger population. Careful clinical, biochemical and radiological evaluation, site of AVF creation selection in elderly may reduce AVF failure rate.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.