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

Study examines survival rates linked with different dialysis procedures to access the blood

2013-06-28

(Press-News.org) Washington, DC (June 27, 2013) — 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."

### Highlights Elderly kidney failure patients using catheters to access the blood for dialysis have the highest risks of dying prematurely compared with patients using other types of vascular access. Two other types of vascular access—arteriovenous fistulas and arteriovenous grafts—provide similar survival advantages for elderly dialysis patients.

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

Disclosures: The authors reported no financial disclosures.

The article, entitled "Fistula First is Not Always the Best Strategy for the Elderly," will appear online at http://jasn.asnjournals.org/ on June 27, 2013, doi: 10.1681/ASN.2012060632.

The editorial, entitled "Vascular Access for Hemodialysis in Older Adults: A 'Patient First' Approach," will appear online at http://jasn.asnjournals.org/ on June 27, 2013, doi: 10.1681/ASN.2013050507.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14.000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

ELSE PRESS RELEASES FROM THIS DATE:

Study reveals key step in protein synthesis

2013-06-28

Scientists at the University of California, Santa Cruz, have trapped the ribosome, a protein-building molecular machine essential to all life, in a key transitional state that has long eluded researchers. Now, for the first time, scientists can see how the ribosome performs the precise mechanical movements needed to translate genetic code into proteins without making mistakes. "This is something that the whole field has been pursuing for the past decade," said Harry Noller, Sinsheimer Professor of Molecular Biology at UC Santa Cruz. "We've trapped the ribosome in the ...

Brain's 'garbage truck' may hold key to treating Alzheimer's and other disorders

2013-06-28

In a perspective piece appearing today in the journal Science, researchers at University of Rochester Medical Center (URMC) point to a newly discovered system by which the brain removes waste as a potentially powerful new tool to treat neurological disorders like Alzheimer's disease. In fact, scientists believe that some of these conditions may arise when the system is not doing its job properly. "Essentially all neurodegenerative diseases are associated with the accumulation of cellular waste products," said Maiken Nedergaard, M.D., D.M.Sc., co-director of the URMC ...

Spanish researchers reformulate the model of mitochondrial function

2013-06-28

The discovery confirms the model proposed by the team in 2008 to account for observations that could not be explained by the established model of mitochondrial function. Mitochondria are the organelles in the interior of cells that, among other functions, extract energy from nutrients and convert it into a form that can be used by the cell for its vital processes. The consumption, digestion and assimilation of nutrients serves the ultimate purpose of fueling each and every cell in the body. The breakdown of nutrients in the digestive tract requires energy to release simple ...

Early brain stimulation may help stroke survivors recover language function

2013-06-28

Non-invasive brain stimulation may help stroke survivors recover speech and language function, according to new research in the American Heart Association journal Stroke. Between 20 percent to 30 percent of stroke survivors have aphasia, a disorder that affects the ability to grasp language, read, write or speak. It's most often caused by strokes that occur in areas of the brain that control speech and language. "For decades, skilled speech and language therapy has been the only therapeutic option for stroke survivors with aphasia," said Alexander Thiel, M.D., study ...

South Asians need more exercise than white Europeans to reduce diabetes risk, say scientists

2013-06-28

South Asians (from India, Pakistan, Bangladesh) may have to exercise more than white Europeans to achieve the same levels of fitness and reduce their risk of diabetes. Researchers at the University of Glasgow have found that lower fitness levels in middle-aged men of South Asian origin are contributing to higher blood sugar levels and increased diabetes risk compared with white men. The research, published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), suggests that physical activity guidelines may need to be changed to take ...

Research from Boston University and USC promises breakthrough in internet bandwidth

2013-06-28

VIDEO: Researchers were able increase data flow through fiber optic cables by moving light through them in a spiral motion, rather than a straight line. Click here for more information. As rapidly increasing demand for bandwidth strains the Internet's capacity, a team of engineers has devised a new fiber optic technology that promises to increase bandwidth dramatically. The new technology could enable Internet providers to offer much greater connectivity – from decreased network ...

Higher genetic risk tied to lifetime asthma suffering

2013-06-28

DURHAM, N.C. -- Children with more genetic risks for asthma are not only more likely to develop the condition at a young age, but they are also more likely to continue to suffer with asthma into adulthood. The finding reported by Duke University researchers is one of the latest to come from a 40-year longitudinal study of New Zealanders. "We've been able to look at how newly discovered genetic risks relate to the life course of asthma at an unprecedented level of resolution," said Daniel Belsky, a postdoctoral fellow at the Duke Institute for Genome Sciences & Policy ...

Researchers discover global warming may affect microbe survival

2013-06-28

The findings are featured as the cover story of the June 28 edition of the journal Science. An international research team led by Ferran Garcia-Pichel, microbiologist and professor with ASU's School of Life Sciences, conducted continental-scale surveys of the microbial communities that live in soil crusts. The scientists collected crust samples from Oregon to New Mexico, and Utah to California and studied them by sequencing their microbial DNA. While there are thousands of microbe species in just one pinch of crust, two cyanobacteria —bacteria capable of photosynthesis ...

Lithium reduces risk of suicide in people with mood disorders

2013-06-28

The authors say the drug "seems to reduce the risk of death and suicide by more than 60% compared with placebo" and suggest this review "reinforces lithium as an effective agent to reduce the risk of suicide in people with mood disorders." Mood disorders are a leading cause of global disability. The two main types are unipolar disorder (often called clinical depression) and bipolar disorder (often called manic depression). Both are serious, long term conditions involving extreme mood swings, but people with bipolar depression also experience episodes of mania or hypomania. ...

Fatty acids found in fish linked to lower risk of breast cancer

2013-06-28

The results show that each 0.1 g per day or 0.1% energy per day increment of intake of n-3 polyunsaturated fatty acid (n-3 PUFA) derived from fish was associated with a 5% reduction in risk. To achieve this risk reduction, intake of oily fish such as salmon, tuna or sardines should be 1-2 portions per person per week. Breast cancer is one of the most common cancers, accounting for 23% of total cancer cases and 14% of cancer deaths in 2008. Studies suggest that a healthy diet and lifestyle is crucial for the prevention of breast cancer, and dietary fat is one of the most ...

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

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: