A meta-analysis of dialysis access outcome in elderly patients

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Abstract

Background:

Many authors report inferior patency rates of distal arteriovenous fistulas in elderly patients and others present contradictory results. A meta-analysis of available evidence was performed to assess (1) whether non-elderly adults have the same risk of forearm arteriovenous fistula failure as elderly patients with end-stage renal disease and (2) whether such a distal access has the same risk of failure as more proximal access procedures or grafts in elderly patients.

Methods:

A literature search was performed using the MEDLINE and SCOPUS electronic databases. The analysis involved studies that comprised subgroups of elderly patients and compared their outcomes with those of non-elderly adults. Articles comparing patency rates of radial-cephalic and proximal fistulas or grafts in elderly patients were also included. Thirteen relevant studies (all cohort observational studies, 11 retrospective) were identified and included in the final analysis.

Results:

The meta-analysis revealed a statistically significantly higher rate of radial-cephalic arteriovenous fistula failure in elderly patients compared with non-elderly adults at 12 (odds ratio [OR], 1.525;P= .001) and 24 months (OR, 1.357,P= .019). The primary radial-cephalic arteriovenous fistula failure rate was also in favor of the non-elderly adults (OR, 1.79;P= .012). Secondary analysis revealed a pooled effect in favor of the elbow brachiocephalic fistulas that was statistically significant (P= .004) compared with distal fistulas in elderly patients.

Conclusion:

This meta-analysis found an increased risk of radial-cephalic fistula failure in elderly patients and significant benefit from the creation of proximal autologous brachiocephalic fistulas. If confirmed by further prospective studies, these differences should be considered when planning a vascular access in incident elderly patients.

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