Featured Research

from universities, journals, and other organizations

Gold standard dialysis procedure may not be so golden for elderly patients

Date:
June 27, 2013
Source:
American Society of Nephrology (ASN)
Summary:
Elderly patients with kidney failure may not gain the same benefits from what's considered the gold standard for accessing the blood for dialysis compared with younger patients, according to a new study. The findings suggest that vascular access procedures should be tailored to individual dialysis patients in the elderly population.

Elderly patients with kidney failure may not gain the same benefits from what's considered the gold standard for accessing the blood for dialysis compared with younger patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that vascular access procedures should be tailored to individual dialysis patients in the elderly population.

The elderly represent the most rapidly growing group of patients on dialysis for kidney failure. Research clearly shows an arteriovenous fistula, which is created by connecting a patient's own vein and artery to form a long-lasting site through which blood can be removed and returned, is the best way to gain access to the blood for dialysis in younger individuals. Other types of access involve the use of a catheter, which does not require needle sticks, and arteriovenous grafts, which is a plastic conduit between an artery and a vein. It's currently unclear which of these is the best type of dialysis access for elderly patients.

To investigate, Ranil DeSilva, MD, Alexander Goldfarb-Rumyantzev, MD, PhD (Beth Israel Deaconess Medical Center), and their colleagues studied information from 2005 to 2008 on more than 115,000 dialysis patients over 66 years of age, 35% of whom were in their 80s and 90s.

Among the major findings over four years:

• The use of catheters was linked with more than a 74% increased risk of death in patients of any age.

• While use of an arteriovenous fistula improved survival compared with use of an arteriovenous graft in patients in their late 60s and 70s, patients in their 80s and 90s experienced similar survival rates with the two procedures.

The findings suggest that in patients who are older than 80 years, placing a graft -- which takes a much shorter time to establish and can be placed shortly before starting dialysis -- may be a reasonable alternative to a fistula. This is particularly true for those with small veins or when it is uncertain when dialysis may be needed.

"In an era using more standardized quality outcome measures, we must remain cautious about generalizing measures to our growing elderly population. In the case of our study, a strategy that is clearly superior in young individuals requiring hemodialysis for kidney failure does not appear to be the clearly superior strategy for elderly individuals," said Dr. DeSilva. "It appears that the optimal vascular access choice should be tailored to the specific patient in the elderly population," he added.

In an accompanying editorial, Ann O'Hare, MD (University of Washington, Seattle) stressed that "to deliver care that is truly centered on the patient, we may ultimately need to set aside traditional metrics focusing on universal treatment targets… in favor of new ones focusing on the extent to which the process and outcomes of access selection support the goals and preferences of individual patients."

Study co-authors include Bhanu Patibandla, MD, Yael Vin, MD, MPH, Akshita Narra MD, Varun Chawla, MD, and Robert Brown, MD.


Story Source:

The above story is based on materials provided by American Society of Nephrology (ASN). Note: Materials may be edited for content and length.


Journal Reference:

  1. Ranil DeSilva et al. Fistula First is Not Always the Best Strategy for the Elderly. Journal of the American Society of Nephrology, 2013 DOI: 10.1681/ASN.2012060632

Cite This Page:

American Society of Nephrology (ASN). "Gold standard dialysis procedure may not be so golden for elderly patients." ScienceDaily. ScienceDaily, 27 June 2013. <www.sciencedaily.com/releases/2013/06/130627190329.htm>.
American Society of Nephrology (ASN). (2013, June 27). Gold standard dialysis procedure may not be so golden for elderly patients. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2013/06/130627190329.htm
American Society of Nephrology (ASN). "Gold standard dialysis procedure may not be so golden for elderly patients." ScienceDaily. www.sciencedaily.com/releases/2013/06/130627190329.htm (accessed October 22, 2014).

Share This



More Health & Medicine News

Wednesday, October 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

CDC Revamps Ebola Guidelines After Criticism

CDC Revamps Ebola Guidelines After Criticism

Newsy (Oct. 21, 2014) The Centers for Disease Control and Prevention have issued new protocols for healthcare workers interacting with Ebola patients. Video provided by Newsy
Powered by NewsLook.com
WHO: Ebola Vaccine Trials to Start a in January

WHO: Ebola Vaccine Trials to Start a in January

AP (Oct. 21, 2014) Tens of thousands of doses of experimental Ebola vaccines could be available for "real-world" testing in West Africa as soon as January as long as they are deemed safe in soon to start trials, the World Health Organization said Tuesday. (Oct. 21) Video provided by AP
Powered by NewsLook.com
First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

Newsy (Oct. 21, 2014) A medical team has for the first time given a man the ability to walk again after transplanting cells from his brain onto his severed spinal cord. Video provided by Newsy
Powered by NewsLook.com
CDC Issues New Ebola Guidelines for Health Workers

CDC Issues New Ebola Guidelines for Health Workers

Reuters - US Online Video (Oct. 21, 2014) The U.S. Centers for Disease Control and Prevention has set up new guidelines for health workers taking care of patients infected with Ebola. Linda So reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins