Vascular Access Surgery Timing
Kidney360, vol. 7, pp. 2066–2074
Abstract
KEY POINTS: Only 32% of elderly patients with ESKD in Europe started hemodialysis with a functional fistula that was created on time. Vascular access was created early in 42% and late in 26% of patients, exposing these patients to unused fistulas or catheter dependency. Eventually, 90% of all patients after fistula creation started hemodialysis within the mean follow-up period of 30 months. BACKGROUND: Timing vascular access creation for older patients with ESKD is challenging. Autologous arteriovenous fistulas (AVF) are often created too early, leading to unused fistulas, or too late, necessitating central venous catheters (CVC). This study reports on vascular access creation in relation to hemodialysis initiation in European practice. METHODS: This study is a secondary analysis of the European Quality cohort: a prospective observational study that recruited patients aged ≥65 years with stage 4 or 5 CKD from six European countries. Patients were selected once their eGFR dropped below 15 ml/min per 1.73 m 2 , if they received a vascular access, and had at least 6 months of follow-up. Vascular access timing was categorized into three groups: early (no dialysis within 6 months after AVF creation), on time (dialysis initiated with an AVF within 6 months), and late (hemodialysis initiated with a CVC before or within 6 months after AVF creation). RESULTS: A total of 332 patients from the European Quality cohort were analyzed: 221 patients (67%) received an AVF as first vascular access and 111 patients (33%) a CVC. Among the latter, 53 patients (48%) underwent subsequent AVF creation, whereas for the remaining 58 patients, CVC was considered the intended vascular access strategy. At dialysis initiation, 158 patients (54%) used an AVF, while 136 patients (46%) used a CVC. AVF creation was on time in 88 of 274 patients (32%), early in 114 patients (42%), and late in 72 patients (26%). Despite high rates of early AVF creation, most fistulas were eventually used, as 90% of patients initiated hemodialysis within 3 years. CONCLUSIONS: Only 32% of elderly patients with ESKD started hemodialysis with a functional AVF created on time (within the 6-month window), while 42% had early and 26% late creation. Clinical prediction tools are needed to optimize vascular access timing.
Authors 18
-
Boudewijn DC Heggen corresponding
Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
-
Amsterdam Public Health · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
-
Leiden University Medical Center
Affiliation as printed
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
-
Leiden University Medical Center
Affiliation as printed
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
-
Leiden University Medical Center
Affiliation as printed
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
-
Affiliation as printed
Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
-
Affiliation as printed
IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
-
Affiliation as printed
IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
-
Affiliation as printed
Clinical Department of Nephrology, Transplantation Medicine and Internal Diseases, Wroclaw Medical University, Wroclaw, Poland
-
University of Würzburg · Universitätsklinikum Würzburg
Affiliation as printed
Department of Medicine, Division of Nephrology, University of Würzburg, Würzburg, Germany
Interdisciplinary Center for Palliative Medicine, University Hospital Wuerzburg, Würzburg, Germany
-
University of Würzburg · Universitätsklinikum Würzburg
Affiliation as printed
Department of Clinical Research and Epidemiology, Comprehensive heart failure center, University Hospital of Würzburg, Würzburg, Germany
-
North Bristol NHS Trust · University of Bristol
Affiliation as printed
North Bristol NHS Trust, Renal Unit, Bristol, United Kingdom
Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
-
Amsterdam Public Health · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
-
Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Renal unit, department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University hospital, Stockholm, Sweden
-
Maastricht University · Care and Public Health Research Institute
Affiliation as printed
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
-
Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
-
Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
Cited by 0 stored of 0
No patents citing this paper on Lens.org (checked 2026-10-11).