Re-evaluating the Fistula First Initiative in Octogenarians on Hemodialysis

Octogenarians frequently require maintenance hemodialysis (HD) for treatment of stage renal disease ESRD. Although the Fistula First Initiative recommends creating an arteriovenous fistula as the preferred dialysis access method, vascular access selection should be based on life expectancy and funct...

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Published in:	Clinical journal of the American Society of Nephrology 2011-07, Vol.6 (7), p.1663-1667
Main Authors:	Vachharajani, Tushar J, Moossavi, Shahriar, Jordan, Jean R, Vachharajani, Vidula, Freedman, Barry I, Burkart, John M
Format:	Article
Language:	eng
Subjects:	Age Factors Aged, 80 and over Aging Arteriovenous Shunt, Surgical - adverse effects Arteriovenous Shunt, Surgical - mortality Catheterization, Central Venous Comorbidity Female Guideline Adherence Health Services for the Aged Humans Kaplan-Meier Estimate Kidney Failure, Chronic - mortality Kidney Failure, Chronic - therapy Life Expectancy Male North Carolina Patient Selection Practice Guidelines as Topic Renal Dialysis - adverse effects Renal Dialysis - mortality Retrospective Studies Risk Assessment Risk Factors Survival Rate Time Factors Treatment Outcome
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Summary:	Octogenarians frequently require maintenance hemodialysis (HD) for treatment of stage renal disease ESRD. Although the Fistula First Initiative recommends creating an arteriovenous fistula as the preferred dialysis access method, vascular access selection should be based on life expectancy and functional status at treatment initiation. This is a retrospective analysis of 4-year outpatient data (January 1, 2004 through December 31, 2007) of incident octogenarian dialysis population in an academic institution. Thirty-nine of 268 patients were octogenarians with a mean (± SD) age of 83.4 ± 3.4 years, and 25 were men. Kaplan-Meier survival and Fisher's post hoc statistical analyses were performed. Thirty-seven octogenarian patients selected HD and two selected peritoneal dialysis. Among the 37 HD patients, 29 initiated dialysis with a tunneled cuffed catheter, 6 with an arteriovenous fistula, and 2 with an arteriovenous graft. Three patients regained renal function after an average 112 days and one was lost to follow-up. Of the 33 remaining on HD, 8 required nursing home admission and 25 were discharged home after initiating HD. Among these 33, 19 died and 14 remained on HD at the end of study period. Days on dialysis (mean ± SEM) before death in those discharged to a nursing facility versus home were 52.6 ± 14.7 versus 386.1 ± 90.7 (P < 0.05), respectively. Vascular access planning should include assessment of functional status and life expectancy in octogenarian HD patients.
ISSN:	1555-9041 1555-905X