Table 1.

Summary of the recommendations and suggestions from studies on vascular access in the elderly

Author, Journal, Year of publication, and Country	Study design	Patient characteristics	Intervention comparator	Outcomes	Results	Notes
Azevedo, Sem Dial, 2015, France	Retrospective on prospectively collected data	Nonagenarians = 38 patients, mean age 93.9 years	Only AVF, mostly radio-cephalic (n = 30)	PPR and SPR after endovascular treatment of upper limb AVF (stenosis or thrombosis)	PPR = 60 and 43 % at 1 and 2 years; SPR = 95 and 92 % at 1 and 2 years	Endovascular treatment is a valuable approach in nonagenarian patients
Bonforte, JVA, 2000, Italy	Retrospective	198 patients >65 years	Toledo-Pereira, snuff-box, wrist AVF	Primary survival	Best outcome from proximal radial AVF (Toledo-Pereira) in spite of comorbidities	Toledo-Pereira AVF suggested as first access option in the elderly
Borzumati, JVA, 2013, Italy	Retrospective	78 patients mean age 82.5 years		Survival and complication rate for distal, mid arm, proximal AVF	Overall survival 76 and 71 % at 12 and 24 months for AVF	Choice of distal AVF if possible in the elderly AVF is gold standard in both elderly and younger patients
Chang, Sem Dial, 2011, USA	Retrospective USRDS Wave II	764 patients >65 years	AVF vs. AVG diabetics vs. non diabetics	Mortality and intervention referral	No mortality differences AVF vs. AVG, for intervention referral for diabetics and non diabetics	Potential benefits derived from AVF compared to AVG and CVC may not apply universally
Cloudeanos, Ann Vasc Surg, 2015, USA	Retrospective	31 patients, mean age 82 years	32 AVF	PPR, SPR at 1 and 2 years	PPR = 51 and 38 % at 1 and 2 years SPR = 75 % at 1 and 2 years High level of reintervention to maintain patency, high use of CVC Poor survival	Doubts on advantages of AVF in the elderly
De Leur, Vasc Endovsc Surg, 2013, Netherlands	Retrospective	107 AVF in 90 patients, aged 75 years or older	65 RCF vs. 42 BCF	PPR and SPR, QOL	PPR for RCF at 1 year = 31 %, at 2 years = 22 % SPR for RCF at 1 = 58 %, at 2 years = 50 % PPR for BCF at 1 and 2 years = 52 and 41 % SPR for BCF at 1 and 2 years = 70 and 57 %	Significant benefit in creating proximal access QOL high despite a high mortality rate
DeSilva, JASN, 2013, USA	Prospective cohort study	115,425 Incident HD patients Age: 76.9 ± 6.4 years Gender: 52.9 % male	Fistula graft catheter	Mortality	HR: 1.77 CVC vs. AVF (p < 0.001) HR: 1.05 Graft vs. Fistula (p = 0.06)	Fistula was not superior to graft
Hicks, J Vasc Surg, 2015, USA	Retrospective	507791 patients on USRDS 2006–2010	Age group	Mortality	AVF is superior to AVG and CVC regardless of the patient’s age, including in octogenarians	Mortality benefit of AVG over CVC may not apply in older (>89 years) age-groups
Hod, JASN, 2014, USA	Retrospective	17511 patients mean age 76.1 years at the initiation of HD	AVF success group (success) vs. AVG + CVC group (failure)	AVF success initiation of HD using the AVF initially placed, regardless of the functionality and durability	Placing an AVF 6–9 months predialysis in the elderly may not be associated to a better AVF success rate	Success rate AVF use increased as time between creation and HD initiation increased (but not >9 months)
Lazarides, J Vasc Surg, 2007, Greece	Meta analysis	Ten studies: 1171 non elderly and 670 elderly Only five studies with PPR and SPR Elderly >65 years	Patency rate distal vs. proximal AVF or graft	Distal AV: elderly vs. non elderly Distal access in elderly vs. proximal or graft	More risk of failure in distal access in elderly Significant benefit in creating proximal access	A more liberal use of proximal access types may be justified
Murea, CJASN, 2014, USA	Retrospective 2005–2007	464 patients with tCVC:374 non elderly (18–74 years) and 90 elderly (≥75 years)	Risk of CVC infection in age group	Rate of catheter-related bloodstream infection (tCVC)	Hazard ratio = 0.33 for catheter-related bloodstream infection in the elderly	Lower risk of catheter-related bloodstream infection in elderly than younger patients
Nadeau-Fredette, Hemodial Int, 2013, Canadian	Retrospective 2005–2008	55 patients aged >80 years vs. 57 patients 50–60 years	AVF and AVG	Primary Failure (PF) Primary and secondary patency	PF older 40 % vs. 17 % younger patients. PPR similar. Secondary patency shorter in elderly patients (p = 0.005)	Need of a careful selection and evaluation in elderly prior to referral Patient-based approach recommended
Olsha, J. Vasc Surg, 2015, Israel	Retrospective study 2005–2009	146 access in 134 incident and prevalent HD patients Age: 85 ± 2.9 years Gender: 66 % male	128 AVF 18 AVG Forearm, upper arm AVF, AVG	Patency rate, non-maturation rate	PPR 39, 33, and 23 % at 12, 24, and 36 months SPR 92, 83, and 77 % at 12, 24, and 36 months No difference between the different types of access.	Age alone should not disqualify patients older than 80 years from access surgery
Swindlehurst, J. Vasc Surg, 2011, UK	Retrospective on prospectively collected data (6 years) first AV attempt	246 patients >65 years (Group A) 89 patients <65 years (Group B)	AVF and AVG	PP, APP, SP, ACPR, death with functioning conduit, mean conduit survival, failure to mature	Patency rates for different types of conduits were similar between the two groups. Failure to mature >elderly AVG higher cumulative patency in group A	AVF in elderly possible with high patency rate, short hospital stay and low revision rate
Vachharajani, CJASN, 2011, USA	Retrospective	37 Incident HD patients Age: 83.4 ± 3.4 years Gender: 64 % male	Facility HD Home HD	Day HD before death Facility vs home	52 ± 14 vs. 386 ± 90 days (p < 0.05).	Functional status and life expectancy should be assessed
Weale, J. Vasc Surg, 2008, UK	Retrospective	658 patients Median age 68.5 years	RCAVF BCAVF in age groups: <65, 66–79, >80 years	Usability, primary, secondary patency	Age did not affect usability, primary or secondary patency of either RCAVFs or BCAVFs	High failure rate Disagreement with Lazarides study
Weyde, Blood Purif, 2006, Poland	Retrospectve 1998–2004	131 consecutive HD patients Age 79.1 ± 3.6 years Gender: 50 % male	Only AVF considered (92 % forearm)	Successful surgery Primary and secondary AVF patency Patient survival	Successful AVF: 107/131 patients (82 %) PPR: 70 % at 6 months, 59 % at 12 months SPR: 92 % at 6 months, 84 % at 12 months Patient survival: 94 % at 6 months, 88 % at 12 months, 66 % at 3 years, 45 % at 5 years	Possible selection bias. Good patients and AVF survival
Zhang, Hemodial Int, 2014, Canada	Retrospective registry	39.721 incident patients 27 % 65–74 years, 26 % 75–85 years, 5 % >85 years	AV access (AVF and graft) Catheters	Mortality by vascular access and age category	Lower adjusted mortality compared with catheter use in each age category	Understand patient preference, complications, and resource use

AVF arteriovenous fistula, AVG arteriovenous graft, CVC central venous catheter, PPR primary patency rate, SPR secondary patency rate, RCF radiocephalic fistula, BCF brachiocephalic fistula, QOL quality of life, PP primary patency, APP assisted primary patency, SP secondary patency, ACPR assisted cumulative patency rate, PF primary failure