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A meta-analysis of dialysis access outcome in elderly patients Lazarides MK; Georgiadis GS; Antoniou GA; Staramos DNJ Vasc Surg 2007[Feb]; 45 (2): 420-426BACKGROUND: Many authors report inferior patency rates of distal arteriovenous fistulas in elderly patients and others present contradictory results. A meta-analysis of available evidence was performed to assess (1) whether non-elderly adults have the same risk of forearm arteriovenous fistula failure as elderly patients with end-stage renal disease and (2) whether such a distal access has the same risk of failure as more proximal access procedures or grafts in elderly patients. METHODS: A literature search was performed using the MEDLINE and SCOPUS electronic databases. The analysis involved studies that comprised subgroups of elderly patients and compared their outcomes with those of non-elderly adults. Articles comparing patency rates of radial-cephalic and proximal fistulas or grafts in elderly patients were also included. Thirteen relevant studies (all cohort observational studies, 11 retrospective) were identified and included in the final analysis. RESULTS: The meta-analysis revealed a statistically significantly higher rate of radial-cephalic arteriovenous fistula failure in elderly patients compared with non-elderly adults at 12 (odds ratio [OR], 1.525; P = .001) and 24 months (OR, 1.357, P = .019). The primary radial-cephalic arteriovenous fistula failure rate was also in favor of the non-elderly adults (OR, 1.79; P = .012). Secondary analysis revealed a pooled effect in favor of the elbow brachiocephalic fistulas that was statistically significant (P = .004) compared with distal fistulas in elderly patients. CONCLUSION: This meta-analysis found an increased risk of radial-cephalic fistula failure in elderly patients and significant benefit from the creation of proximal autologous brachiocephalic fistulas. If confirmed by further prospective studies, these differences should be considered when planning a vascular access in incident elderly patients.|*Arteriovenous Shunt, Surgical[MESH]|*Blood Vessel Prosthesis Implantation[MESH]|*Vascular Patency[MESH]|Age Factors[MESH]|Aged[MESH]|Forearm/*blood supply[MESH]|Humans[MESH]|Kidney Failure, Chronic/physiopathology/*therapy[MESH]|Middle Aged[MESH]|Odds Ratio[MESH]|Renal Dialysis/*methods[MESH]|Risk Factors[MESH]|Time Factors[MESH]|Treatment Failure[MESH] |