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Vascular access in elderly patients with end-stage renal disease

  • Nephrology - Review
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Abstract

During the last few years, the number of elderly patients with end-stage renal disease (ESRD) has been increasing worldwide. Establishment of a viable vascular access is of primary importance in these patients. This review discusses the advantages and disadvantages of the available vascular access modalities [namely arteriovenous (AV) fistulae, AV grafts, and central venous catheters (CVCs)] in elderly ESRD patients. AV fistulae seem to be superior when compared with other vascular access alternatives with respect to patency, morbidity and mortality rates. On the other hand, due to the age-related advanced atherosclerosis in the elderly, higher failure rates for AV fistulae in this age group have been described. Two controversial issues, namely the higher infection and thrombosis rates in elderly ESRD patients, are also discussed. Current evidence suggests that old age should not comprise a drawback when selecting the appropriate vascular access modality (AV fistula, AV graft or CVC) for the performance of hemodialysis. The possible vascular access options in elderly ESRD patients should not be different from younger individuals.

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References

  1. United States Renal Data System (USRDS) 2007 Annual Data Report. Available at: http://www.usrds.org/2007/pdf/02_incid_prev_07.pdf

  2. Xue JL, Ma JZ, Louis TA et al (2001) Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol 12:2753–2758

    PubMed  CAS  Google Scholar 

  3. Gilbertson DT, Liu J, Xue JL et al (2005) Projecting the number of patients with end-stage renal disease in the United States to the year 2015. J Am Soc Nephrol 16:3736–3741. doi:10.1681/ASN.2005010112

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control, Prevention (CDC) (2008) Hospitalization discharge diagnoses for kidney disease United States, 1980–2005. MMWR Morb Mortal Wkly Rep 57:309–312

    Google Scholar 

  5. Stolzmann KL, Camponeschi JL, Remington PL (2005) The increasing incidence of end-stage renal disease in Wisconsin from 1982–2003: an analysis by age, rage, and primary diagnosis. WMJ 104:66–71

    PubMed  Google Scholar 

  6. Wakai K, Nakai S, Kikuchi K et al (2004) Trends in the incidence of end-stage renal disease in Japan, 1983–2000: age-adjusted and age-specific rates by gender and cause. Nephrol Dial Transplant 19:2044–2052. doi:10.1093/ndt/gfh317

    Article  PubMed  Google Scholar 

  7. Apostolou T (2007) Quality of life in the elderly patients on dialysis. Int Urol Nephrol 39:679–683. doi:10.1007/s11255-007-9225-7

    Article  PubMed  Google Scholar 

  8. Kohli HS, Bhat A, Aravindan AN et al (2006) Spectrum of renal failure in elderly patients. Int Urol Nephrol 38:759–765. doi:10.1007/s11255-006-0089-z

    Article  PubMed  Google Scholar 

  9. Musso CG, Liakopoulos V, Ioannidis I et al (2006) Acute renal failure in the elderly: particular characteristics. Int Urol Nephrol 38:787–793. doi:10.1007/s11255-006-0084-4

    Article  PubMed  Google Scholar 

  10. Prakash J, Hota JK, Singh S et al (2006) Clinical spectrum of chronic renal failure in the elderly: a hospital based study. Int Urol Nephrol 38:821–827. doi:10.1007/s11255-006-9003-y

    Article  PubMed  Google Scholar 

  11. Tseke P, Grapsa E, Stamatelopoulos K et al (2006) Atherosclerotic risk factors and carotid stiffness in elderly asymptomatic HD patients. Int Urol Nephrol 38:801–809. doi:10.1007/s11255-006-9000-1

    Article  PubMed  Google Scholar 

  12. Covic A, Gusbeth-Tatomir P, DJ Goldsmith (2006) The epidemics of cardiovascular disease in elderly patients with chronic kidney disease—two facets of the same problem. Int Urol Nephrol 38:371–379. doi:10.1007/s11255-006-0044-z

    Article  PubMed  Google Scholar 

  13. Soubassi LP, Chiras TC, Papadakis ED et al (2006) Incidence and risk factors of coronary heart disease in elderly patients on chronic hemodialysis. Int Urol Nephrol 38:795–800. doi:10.1007/s11255-006-0039-9

    Article  PubMed  Google Scholar 

  14. Roake J (2004) Dialysis in the elderly. N Z Med J 117:U904

    PubMed  Google Scholar 

  15. Brescia MJ, Cimino JE, Appel K et al (1966) Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 275:1089–1092

    PubMed  CAS  Google Scholar 

  16. National Kidney Foundation. Kidney Dialysis Outcomes Quality Initiative (2001) III. NKF–K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis 37:S137–S181. doi:10.1016/S0272-6386(01)70007-8

    Article  Google Scholar 

  17. Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, Saito A, Young EW, Port FK, Dialysis Outcomes and Practice Patterns Study (2003) Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 63:323–330. doi:10.1046/j.1523-1755.2003.00724.x

    Article  PubMed  Google Scholar 

  18. Brothers TE, Morgan M, Robison JG et al (1996) Failure of dialysis access: revise or replace? J Surg Res 60:312–316. doi:10.1006/jsre.1996.0049

    Article  PubMed  CAS  Google Scholar 

  19. Hakim R, Himmelfarb J (1998) Hemodialysis access failure: a call to action. Kidney Int 54:1029–1040. doi:10.1046/j.1523-1755.1998.00122.x

    Article  PubMed  CAS  Google Scholar 

  20. Churchill DN, Taylor DW, Cook RJ et al (1992) Canadian hemodialysis morbidity study. Am J Kidney Dis 19:214–234

    PubMed  CAS  Google Scholar 

  21. Kherlakian GM, Roedersheimer LR, Arbaug JJ et al (1986) Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in haemodialysis. Am J Surg 152:238–243. doi:10.1016/0002-9610(86)90249-7

    Article  PubMed  CAS  Google Scholar 

  22. Kizilisik AT, Kim SB, Nylander WA et al (2004) Improvements in dialysis access survival with increasing use of arteriovenous fistulas in a veterans administration medical center. Am J Surg 188:614–616. doi:10.1016/j.amjsurg.2004.07.023

    Article  PubMed  Google Scholar 

  23. Rodriguez JA, Lopez J, Cleries M et al (1999) Vascular access for haemodialysis an epidemiological study of the Catalan Renal Registry. Nephrol Dial Transplant 14:1651–1657. doi:10.1093/ndt/14.7.1651

    Article  PubMed  CAS  Google Scholar 

  24. Quarello F, Forneris G, Borca M et al (2006) Do central venous catheters have advantages over arteriovenous fistulas or grafts? J Nephrol 19:265–279

    PubMed  Google Scholar 

  25. Cetinkaya R, Odabas AR, Unlu Y et al (2003) Using cuffed and central venous catheters as permanent vascular access for hemodialysis: a prospective study. Ren Fail 25:431–438. doi:10.1081/JDI-120021155

    Article  PubMed  Google Scholar 

  26. Lee T, Barker J, Allon M (2005) Tunnelled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis 46:501–508. doi:10.1053/j.ajkd.2005.05.024

    Article  PubMed  Google Scholar 

  27. Jean G, Charra B, Chazot C et al (2002) Risk factor analysis of long-term tunnelled dialysis catheter-related bacteremias. Nephron 91:399–405. doi:10.1159/000064279

    Article  PubMed  CAS  Google Scholar 

  28. Butterly DW, Schwab SJ (2001) Catheter access for hemodialysis: an overview. Semin Dial 14:411–415. doi:10.1046/j.1525-139x.2001.00104.x

    Article  PubMed  CAS  Google Scholar 

  29. Schwab SJ, Quarles LD, Middleton JP et al (1988) Hemodialysis-associated subclavian vein stenosis. Kidney Int 33:1156–1159. doi:10.1038/ki.1988.124

    Article  PubMed  CAS  Google Scholar 

  30. Lee SJ, Neiberger R (1991) Subclavian vein stenosis: complication of subclavian vein catheterization for hemodialysis. Child Nephrol Urol 11:212–214

    PubMed  CAS  Google Scholar 

  31. Schwab SJ (1994) Assessing the adequacy of vascular access and its relationship to patient outcome. Am J Kidney Dis 24:316–320

    PubMed  CAS  Google Scholar 

  32. Latos DL (2002) Hemodialysis in the elderly: vascular access and initiation of renal replacement therapy. Semin Dial 15:91–93. doi:10.1046/j.1525-139X.2002.00031.x

    Article  PubMed  Google Scholar 

  33. Culp K, Flanigan M, Taylor L et al (1995) Vascular access thrombosis in new hemodialysis patients. Am J Kidney Dis 26:341–346. doi:10.1016/0272-6386(95)90655-X

    Article  PubMed  CAS  Google Scholar 

  34. Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J, CHOICE Study (2005) Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol 16:1449–1455. doi:10.1681/ASN.2004090748

    Article  PubMed  Google Scholar 

  35. Dhingra RK, Young EW, Hulbert-Shearon TE et al (2001) Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int 60:1443–1451. doi:10.1046/j.1523-1755.2001.00947.x

    Article  PubMed  CAS  Google Scholar 

  36. Woods JD, Turenne MN, Strawderman RL et al (1997) Vascular access survival among incident hemodialysis patients in the United States. Am J Kidney Dis 30:50–57. doi:10.1016/S0272-6386(97)90564-3

    Article  PubMed  CAS  Google Scholar 

  37. Xue JL, Dahl D, Ebben JP et al (2003) The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis 42:1013–1019

    Article  PubMed  Google Scholar 

  38. Shemesh D, Zigelman C, Olsha O et al (2003) Primary forearm arteriovenous fistula for hemodialysis access—an integrated approach to improve outcomes. Cardiovasc Surg 11:35–41. doi:10.1016/S0967-2109(02)00148-5

    Article  PubMed  CAS  Google Scholar 

  39. Jenning WC (2006) Creating arteriovenous fistulas in 132 consecutive patients: exploiting the proximal radial artery arteriovenous fistula: reliable, safe, and simple forearm and upper arm hemodialysis access. Arch Surg 141:27–32. doi:10.1001/archsurg.141.1.27

    Article  Google Scholar 

  40. Gracz KC, Ing TS, Soung LS et al (1977) Proximal forearm fistula for maintenance hemodialysis. Kidney Int 11:71–75. doi:10.1038/ki.1977.9

    Article  PubMed  CAS  Google Scholar 

  41. Fitzgerald JT, Schanzer A, Chin AI et al (2004) Outcomes of upper arm arteriovenous fistulas for maintenance hemodialysis access. Arch Surg 139:201–208. doi:10.1001/archsurg.139.2.201

    Article  PubMed  Google Scholar 

  42. Didlake R, Raju S, Rhodes RS et al (1991) Dialysis access in patients older than 65 years. In: Sommer BG, Henry ML (eds) Vascular access for hemodialysis II. W.L. Gore and Associates, Inc., Boston, p 166

    Google Scholar 

  43. Dobkin JF, Miller MH, Steigbigel NH (1978) Septicemia in patients on chronic hemodialysis. Ann Intern Med 88:28–33

    PubMed  CAS  Google Scholar 

  44. Tang IY, Vrachnos D, Valaitis D et al (1992) Vascular access thrombosis during recombinant human erythropoietin therapy. ASAIO J 38:M528–M531. doi:10.1097/00002480-199207000-00091

    Article  PubMed  CAS  Google Scholar 

  45. Ravani P, Marcelli D, Malberti F (2002) Vascular access surgery managed by renal physicians: the choice of native arteriovenous fistulas for hemodialysis. Am J Kidney Dis 40:1264–1276. doi:10.1053/ajkd.2002.36897

    Article  PubMed  Google Scholar 

  46. Ravani P, Brunori G, Mandolfo S et al (2004) Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: a prospective multicenter study. J Am Soc Nephrol 15:204–209. doi:10.1097/01.ASN.0000103870.31606.90

    Article  PubMed  Google Scholar 

  47. Verhallen AM, Kooistra MP, van Jaarsveld BC (2007) Cannulating in haemodialysis: rope-ladder or buttonhole technique? Nephrol Dial Transplant 22:2601–2604. doi:10.1093/ndt/gfm043

    Article  PubMed  Google Scholar 

  48. Ball LK, Treat L, Riffle V et al (2007) A multi-center perspective of the Buttonhole Technique in the Pacific Northwest. Nephrol Nurs J 34:234–241

    PubMed  Google Scholar 

  49. Murcutt G (2008) Buttonhole cannulation: should this become the default technique for dialysis patients with native fistulas? Summary of the EDTNA/ERCA Journal Club discussion Autumn 2007. J Ren Care 34:101–108. doi:10.1111/j.1755-6686.2008.00019.x

    Article  PubMed  Google Scholar 

  50. Lok CE, Oliver MJ, Su J et al (2005) Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int 67:2462–2469. doi:10.1111/j.1523-1755.2005.00355.x

    Article  PubMed  Google Scholar 

  51. Wolowczyk L, Williams AJ, Donovan KL et al (2000) The snuffbox arteriovenous fistula for vascular access. Eur J Vasc Endovasc Surg 19:70–76. doi:10.1053/ejvs.1999.0969

    Article  PubMed  CAS  Google Scholar 

  52. Grapsa EJ, Paraskevopoulos AP, Moutafis SP et al (1998) Complications of vascular access in hemodialysis (HD)—aged vs. adult patients. Geriatr Nephrol Urol 8:21–24. doi:10.1023/A:1008242100893

    Article  PubMed  CAS  Google Scholar 

  53. Golledge J, Smith CJ, Emery J et al (1999) Outcome of primary radiocephalic fistula for haemodialysis. Br J Surg 86:211–216. doi:10.1046/j.1365-2168.1999.01007.x

    Article  PubMed  CAS  Google Scholar 

  54. Burt CG, Little JA, Mosquera DA (2001) The effect of age on radiocephalic fistula patency. J Vasc Access 2:110–113

    PubMed  CAS  Google Scholar 

  55. Ridao-Cano N, Polo JR, Polo J et al (2002) Vascular access for dialysis in the elderly. Blood Purif 20:563–568. doi:10.1159/000066961

    Article  PubMed  Google Scholar 

  56. Obialo CI, Tagoe AT, Martin PC et al (2003) Adequacy and survival of autogenous arteriovenous fistula in African American hemodialysis patients. ASAIO J 49:435–439

    PubMed  Google Scholar 

  57. Prischl FC, Kirchgatterer A, Brandstatter E et al (1995) Parameters of prognostic relevance to the patency of vascular access in hemodialysis patients. J Am Soc Nephrol 6:1613–1618

    PubMed  CAS  Google Scholar 

  58. Kim YO, Choi YJ, Kim JI et al (2006) The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. J Korean Med Sci 21:284–289

    Article  PubMed  Google Scholar 

  59. Lin SL, Huang CH, Chen HS et al (1998) Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol 18:96–100. doi:10.1159/000013315

    Article  PubMed  CAS  Google Scholar 

  60. Wasse H, Speckman RA, Frankenfield DL et al (2007) Predictors of delayed transition from central venous catheter use to permanent vascular access among ESRD patients. Am J Kidney Dis 59:276–283. doi:10.1053/j.ajkd.2006.11.030

    Article  Google Scholar 

  61. Lenz O, Sadhu S, Fornoni A et al (2006) Overutilization of central venous catheters in incident hemodialysis patients: reasons and potential resolution strategies. Semin Dial 19:543–550. doi:10.1111/j.1525-139X.2006.00220.x

    Article  PubMed  Google Scholar 

  62. Windus DW (1994) The effect of comorbid conditions on hemodialysis access patency. Adv Ren Replace Ther 1:148–154

    PubMed  CAS  Google Scholar 

  63. Leapman SB, Boyle M, Pescovitz MD et al (1996) The arteriovenous fistula for hemodialysis access: gold standard or archaic relic? Am Surg 62:652–656

    PubMed  CAS  Google Scholar 

  64. Ponikvar R, Buturovic-Ponikvar J (2005) Temporary hemodialysis catheters as a long-term vascular access in chronic hemodialysis patients. Ther Apher Dial 9:250–253. doi:10.1111/j.1774-9987.2005.00265.x

    Article  PubMed  Google Scholar 

  65. Garcia Falcon T, Rodriguez-Carmona A, Perez Fontan M et al (1994) Complications of permanent catheter implantation for peritoneal dialysis: incidence and risk factors. Adv Perit Dial 10:206–209

    PubMed  CAS  Google Scholar 

  66. Jean G, Charra B, Chazot C et al (2001) Long-term outcome of permanent hemodialysis catheters: a controlled study. Blood Purif 19:401–407. doi:10.1159/000046971

    Article  PubMed  CAS  Google Scholar 

  67. Levin A, Mason AJ, Jindal KK et al (1991) Prevention of hemodialysis subclavian vein catheter infections by topical povidone–iodine. Kidney Int 40:934–938. doi:10.1038/ki.1991.297

    Article  PubMed  CAS  Google Scholar 

  68. Boelaert JR, Van Landuyt HW, Godard CA et al (1993) Nasal mupirocin ointment decreases the incidence of Staphylococcus aureus bacteraemias in haemodialysis patients. Nephrol Dial Transplant 8:235–239

    PubMed  CAS  Google Scholar 

  69. Sesso R, Barbosa D, Leme IL et al (1998) Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment. J Am Soc Nephrol 9:1085–1092

    PubMed  CAS  Google Scholar 

  70. Rupp ME, Lisco SJ, Lipsett PA et al (2005) Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med 143:570–580

    PubMed  CAS  Google Scholar 

  71. Maki DG, Stolz SM, Wheeler S et al (1997) Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 127:257–266

    PubMed  CAS  Google Scholar 

  72. Darouiche RO, Raad II, Heard SO et al (1999) A comparison of two antimicrobial-impregnated central venous catheters Catheter Study Group. N Engl J Med 340:1–8. doi:10.1056/NEJM199901073400101

    Article  PubMed  CAS  Google Scholar 

  73. Betjes MG, van Agteren M (2004) Prevention of dialysis catheter-related sepsis with a citrate–taurolidine-containing lock solution. Nephrol Dial Transplant 19:1546–1551. doi:10.1093/ndt/gfh014

    Article  PubMed  CAS  Google Scholar 

  74. Sodemann K, Polaschegg HD, Feldmer B (2001) Two years’ experience with Dialock and CLS (a new antimicrobial lock solution). Blood Purif 19:251–254. doi:10.1159/000046950

    Article  PubMed  CAS  Google Scholar 

  75. Meeus G, Kuypers DR, Claes K et al (2005) A prospective, randomized, double-blind crossover study on the use of 5% citrate lock versus 10% citrate lock in permanent hemodialysis catheters. Blood Purif 23:101–105. doi:10.1159/000083203

    Article  PubMed  CAS  Google Scholar 

  76. Allon M (2003) Prophylaxis against dialysis catheter-related bacteremia with a novel antimicrobial lock solution. Clin Infect Dis 36:1539–1544. doi:10.1086/375234

    Article  PubMed  Google Scholar 

  77. Feely T, Copley A, Bleyer AJ (2007) Catheter lock solutions to prevent bloodstream infections in high-risk hemodialysis patients. Am J Nephrol 27:24–29. doi:10.1159/000098541

    Article  PubMed  CAS  Google Scholar 

  78. Lok CE, Stanley KE, Hux JE et al (2003) Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol 14:169–179. doi:10.1097/01.ASN.0000038688.76195.A4

    Article  PubMed  CAS  Google Scholar 

  79. Stats KJ, Vanwalleghem J, De Moor B et al (2001) Trisodium citrate 30% vs heparin 5% as catheter lock in the interdialytic period in twin- or double-lumen dialysis catheters for intermittent haemodialysis. Nephrol Dial Transplant 16:1521–1522. doi:10.1093/ndt/16.7.1521-a

    Article  Google Scholar 

  80. Lok CE, Appleton D, Bhola C et al (2007) Trisodium citrate 4%—an alternative to heparin capping of haemodialysis catheters. Nephrol Dial Transplant 22:477–483. doi:10.1093/ndt/gfl570

    Article  PubMed  CAS  Google Scholar 

  81. Buturovic J, Ponikvar R, Kandus A et al (1998) Filling hemodialysis catheters in the interdialytic period: heparin versus citrate versus polygeline: a prospective randomized study. Artif Organs 22:945–947. doi:10.1046/j.1525-1594.1998.06268.x

    Article  PubMed  CAS  Google Scholar 

  82. Hendrickx L, Kuypers D, Evenepoel P et al (2001) A comparative prospective study on the use of low concentrate citrate lock versus heparin lock in permanent dialysis catheters. Int J Artif Organs 24:208–211

    PubMed  CAS  Google Scholar 

  83. Macrae JM, Dojcinovic I, Djurdrjev O et al (2008) Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS). Clin J Am Soc Nephrol 3:369–374. doi:10.2215/CJN.01760407

    Article  PubMed  CAS  Google Scholar 

  84. Lazarides MK, Georgiadis GS, Antoniou GA et al (2007) A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 45:420–426. doi:10.1016/j.jvs.2006.10.035

    Article  PubMed  Google Scholar 

  85. Weal AR, Bevis P, Neary WD et al (2008) Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly. J Vasc Surg 47:144–150. doi:10.1016/j.jvs.2007.09.046

    Article  Google Scholar 

  86. Berardinelli L, Vegeto A (1998) Lessons from 494 permanent accesses in 348 haemodialysis patients older than 65 years of age: 29 years of experience. Nephrol Dial Transplant 13(Suppl 7):73–77. doi:10.1093/ndt/13.suppl_7.73

    Article  PubMed  Google Scholar 

  87. Chan MR, Sanchez RJ, Young HN et al (2007) Vascular access outcomes in the elderly hemodialysis population: A USRDS study. Semin Dial 20:606–610. doi:10.1111/j.1525-139X.2007.00370.x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Vascular Surgery, “Red Cross” Hospital, 24, Papagou Street, N. Iraklio, Athens, 14122, Greece

    Nikolaos Bessias, Kosmas I. Paraskevas & Vassilios Andrikopoulos

  2. Department of Nephrology, “Henry Dunant” Hospital, Athens, Greece

    Effie Tziviskou

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  1. Nikolaos Bessias
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  2. Kosmas I. Paraskevas
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  3. Effie Tziviskou
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  4. Vassilios Andrikopoulos
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Correspondence to Kosmas I. Paraskevas.

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Bessias, N., Paraskevas, K.I., Tziviskou, E. et al. Vascular access in elderly patients with end-stage renal disease. Int Urol Nephrol 40, 1133–1142 (2008). https://doi.org/10.1007/s11255-008-9464-2

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