Vascular access for dialysis in the elderly

The purpose of this presentation was the retrospective analysis of a series of angioaccesses for dialysis in order to compare early and late results i n patients either older or younger than 65 years. From January 1992 to Marc h 1997, 1250 vascular accesses for hemodialysis were performed in 1097 pati ents. Follow-up was of 93,7%. Autologous fistulae were performed most frequ ently than grafts. The difference between grafts needed in young patients ( 35%) and old patients (45%) was significant (p < 0.001). In patients withou t previous angioaccess, graft accesses were performed in 26% of young patie nts and 35% of old patients (p < 0.01). In patients with other failed angio accesses, grafts accesses were performed in 55% of young patients and 65% o f old patients (p < 0.05). Early failure of native fistulas was 5.3% in you ng patients and 1.9% in old patients (p < 0.01). Early failure in graft fis tulae was 3.8% in old patients and 2.2% in young patients (not significant) . Complication rate in autologous fistulas was 0.16 per fistula-year in you ng patients and 0.25 per fistula year in old patients (p < 0.001). Complica tion rate in grafts was 0.53 per graft-year in young patients, and 0.68 per graftyear in old patients (not significant). There was not significant dif ferences in comparison of cumulative patency rates of both autologous and g raft accesses in patients younger or older than 65 years. In the elderly, a secondary cumulative patency rate of 72% at three years was observed for a utologous fistulae, and a secondary cumulative patency of 70% at three year s was observed in grafts. In both curves standard error at three years was less than 0.05. After these findings, it can be concluded that an autologou s access, either radio-cephalic or antecubital fistula, is the best angiocc es for dialysis in older patients and can be performed in most of predialys is cases.