Best hemodialysis access in elderly with end stage kidney disease

What is the Best hemodialysis access in elderly with end stage kidney disease (ESKD)?

While arteriovenous fistula is considered the optimal access for long-term hemodialysis, benefits and risk assessment including comorbidity, frailty, nutritional status, performance status, life expectancy, vascular disease, ability to undergo surgical access, risk for infection, and quality of life are important factors to assess for older individuals in determining the optimal access for each person.

With numerous factors contributing to overall success in arteriovenous access, those with low comorbidities, expected longer survival, and good functional status may benefit from arteriovenous fistula placement, whereas those older individuals with lower functional status and increased comorbidities may benefit from arteriovenous graft survival. However, older individuals with high comorbidity status, poor functional status, and overall decreased long-term expected survival may benefit from tunneled central venous catheter placement.

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