TITLE: Outcomes of arteriovenous fistula in elderly patients on maintenance haemodialysis.

BACKGROUND: 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.

METHODS: 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).

RESULTS: 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.

CONCLUSION: 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.

SOURCE: Liu P, Pang SC, Li H, et al. Outcomes of arteriovenous fistula in elderly patients on maintenance haemodialysis[J]. Int Urol Nephrol, 2021, DOI: 10.1007/s11255-021-02822-w.

背景：在接受血液透析（HD）的老年患者中，最佳血管通路策略仍存在争议。我们旨在报告在我们中心，动静脉内瘘（AVF）在以维持性血液透析开始的老年患者的应用效果。

方法：回顾性分析2010年至2012年在三级中心就诊的688例HD患者的病历。比较了<65岁（非老年人），65-75岁（早期老年人）和75岁（晚期老年人）患者的特征和AVF效果。

结果：非老年患者418例，早期老年184例，晚期老年86例。在晚期老年人中产生的肱-头和肱-贵要内瘘比例更高（24.9％ vs. 37.0％ vs. 41.8％，p = 0.001）。在3个年龄组中，功能性AVF的比例相似（80.4％ vs. 79.3％ vs. 75.6％，p = 0.832），以及1年，3年和5年一级和二级通畅率，这些结果在三个年龄组中具有可比性（分别为p = 0.351和0.282）。然而，晚期老年患者需要更长的成熟时间（2.78 vs. 2.86 vs. 3.72个月，p = 0.010）和更高的平均干预次数以辅助首次AVF的成熟（ 0.19 vs. 0.22 vs. 0.35，p= 0.014）。在创建AVF之后，非老年人，早期和晚期老年人的中位患者生存率分别为65.2、55.1和49.8个月。

结论：老年患者建立的AVF与非老年患者相比，具有可比的结果，尽管需要更多干预措施以延长成熟时间来帮助成熟，但需要尽早创建，以允许由于成熟延迟而需要的时间。

启发：因老年患者需要更多的时间等待内瘘成熟，应更加提前建立内瘘，并强调内瘘的可用性，可选择近端内瘘。