Clinical Research Center

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Geriatric hemodialysis patients: a comparative study of vascular access.

K. Culp; L. Taylor; P.A. Hulme (Profiled Author: Polly Adele Hulme)

ANNA journal / American Nephrology Nurses' Association 1996;23(6):583-590, 622; discussion 591-592.

OBJECTIVES: To compare vascular access in hemodialysis patients > or = 65 years of age with those < 65 years on the following: 1) comorbid disease status, 2) types of vascular access used, and 3) outcome. SAMPLE/SETTING: Hemodialysis patients in a four-state region (Iowa, Kansas, Nebraska, and Missouri) from both free-standing and hospital-affiliated providers were sampled (n = 267). A stratified sampling strategy was used in order to obtain approximately equal-sized age groups (< 65 years and > or = 65 years). DESIGN: A descriptive, longitudinal study with a 1-year follow-up period. METHODS: Following the placement of a permanent vascular access, information was collected by the dialysis nursing staff about the configuration of the access, needle gauge used for cannulation, dialysis prescriptions, diabetic status, and other comorbid disease conditions. Odds ratios (OR) for vascular access thrombosis (VAT) risk were calculated between the two age groups. RESULTS: Comparisons between the two age groups suggest a higher frequency of polytetrafluorethylene (PTFE) grafts in the > or = 65-year-old age group. Peripheral vascular disease (PVD) prevalence was also higher in elders. Oral anticoagulants reduced the risk of VAT in those < 65-year-old group. Patients age > or = 65 years with a PTFE graft experienced a higher risk of VAT (OR 3.38, 95% confidence interval 1.43, 8.11) than those in the same age group with an arteriovenous fistula (AVF). CONCLUSIONS: PTFE grafts are used more frequently among geriatric hemodialysis patients, possibly due to the increased prevalence of peripheral vascular disease (PVD). While use of oral anticoagulants is effective in reducing the risk of VAT among those < 65 years, it did not significantly reduce VAT risk in geriatric hemodialysis patients. This observation may be due to the higher frequencies of PTFE grafts in elderly patients.

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