Outcome of Autogenous Arteriovenous Fistula for Hemodialysis in Elderly Patients with End Stage Renal Disease
Keywords:arteriovenous fistula, diabetes, end stage renal disease, hemodialysis
AbstractObjective: To study functional outcomes, in terms of 1-, 3-, 5-year patency rate and post-operative
complications in patients with end-stage renal disease (ESRD) who underwent autogenous arteriovenous fistulas
for hemodialysis and to compare the outcomes in patients aged over 60 years and those of patients age under
Materials and Methods: All records of the patients who underwent autogenous arteriovenous fistula
between January 2003 and June 2007 were reviewed. The patency rates and complications were analyzed in both
groups. The statistic analysis included chi-square test, independent samples t-test, Fisher’s exact test, Kaplan-
Meier survival analysis with log rank test comparison and Cox regression analysis.
Results: From 343 patients, 217 patients met the inclusion criteria. All were divided into two groups
according to the age group. Group 1 (age over 60 years) consisted of 112 patients and Group 2 (age under 60
years) consisted of 105 patients. There were no differences in terms of gender, co-morbid diseases, type of
arteriovenous fistula and biochemical data before operation but only differences in duration of ESRD before operation
(p = 0.028). The patency rates at 1, 3 and 5 years were 76.8%, 54.5% and 48.2% for patients aged over 60 and 81%,
65.2% and 53.3% for patients aged under 60, respectively. There were no significant differences in patency rate for
AVF between both groups (p-value = 0.387). In age over 60 years group, gender and type of fistula were not significant
differences in patency but diabetes was significant differences in patency (p = 0.001). There were no significant
differences in complication between both groups. Multivariate analysis demonstrated significant correlation between
the patency loss and these variables: diabetes (HR = 2.837; 95%CI = 1.912-4.208, p <0.001), active bleeding or
hematoma at surgical site (HR = 4.281; 95%CI = 1.328-13.795, p = 0.015) and surgical site infection (HR = 8.642; 95%
CI = 3.079-24.255, p <0.001).
Conclusion: Autogenous arteriovenous fistula is the first angioaccess for hemodialysis also in older
patients. Survival of the autogenous arteriovenous fistula is independent of age. There is no difference in
autogenous arteriovenous fistula complications across age groups. Diabetes were related to patency loss in older
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