A critical review of the current evidence on vascular access in elderly HD patients
A new article of the European Dialysis (EUDIAL) Working Group of ERA-EDTA critically reviews the current evidence on VA in elderly HD patients and concludes that a pragmatic patient-centred approach is mandatory.Current evidence suggests that arteriovenous fistulas (AVF) should still be the first choice vascular access (VA) for the majority of elderly individuals starting haemodialysis.
Arteriovenous grafts (AVG) placement might be an appropriate option in the elderly patients with no usable forearm veins, in those with a limited life expectancy, those who are rapidly progressing and may not have time to wait for AVF maturation, and in certain subgroups, such as older patients, particularly women with diabetes mellitus. The aim is to avoid the central venous catheters (CVCs) with their inherent high infection risk. However, a CVC may be the best VA in some clinical conditions and end-of-life situations and may even convey cardiac as well as efficiency benefits, regardless of age.
