ArticleJournal of the American Society of Nephrology : JASN2013
Fistula first is not always the best strategy for the elderly.
Article in Journal of the American Society of Nephrology : JASN, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03545113 (A Randomized Pilot Study Comparing Graft-first to Fistula-first Strategies in Older Patients With Incident End-stage Kidney Disease), which is not on this map. Cited by 63 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Pilot Study Comparing Graft-first to Fistula-first Strategies in Older Patients With Incident End-stage Kidney Disease
Who cites it
63 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A meta-analysis of the impact of initial hemodialysis access type on mortality in elderly incident hemodialysis population.BMC geriatrics · 2025Pooled it
- Systematic review of interventions to increase the use of arteriovenous fistulae and grafts in incident haemodialysis patients.The journal of vascular access · 2022Pooled it
- The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology.Journal of nephrology · 2016Guideline
- Risks of arteriovenous fistula failure in hemodialysis patients older than 75 years.Clinical and experimental nephrology · 2026Article
- Mortality risk associated with permanent central venous catheter use in the oldest-old population: a nationwide cohort study.The Korean journal of internal medicine · 2026Article
- Evaluation and comparison of patency rate and complications of synthetic arteriovenous grafts in the groin and upper extremities among hemodialysis patients.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2026Article
- Clinical challenges and individualized approaches to dialysis therapy in older adults.The Korean journal of internal medicine · 2025Review
- Impact of prepared vascular access on mortality and medical expenses in elderly and non-elderly Japanese patients with chronic kidney disease stage G5: a retrospective cohort study.Clinical and experimental nephrology · 2025Article
- Prediction model for 6-month mortality in incident older hemodialysis patients in South Korea.Kidney research and clinical practice · 2025Article
- ARTERIOVENOUS FISTULA FOR HEMODIALYSIS IN RELATION TO THE TIMING OF CREATION: ANALYSIS OF KEY FACTORS.Acta clinica Croatica · 2024Article
- Shared decision making in elderly patients with kidney failure.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Review
- Patients, healthcare providers, and general population preferences for hemodialysis vascular access: a discrete choice experiment.Frontiers in public health · 2024Article
- The reasons for comparative effectiveness clinical trials of arteriovenous fistula versus graft strategy in older adults on hemodialysis with a catheter.Clinical nephrology · 2023Article
- Article
- Study protocol of a randomized controlled trial of fistula vs. graft arteriovenous vascular access in older adults with end-stage kidney disease on hemodialysis: the AV access trial.BMC nephrology · 2023Article
- Association of Four Types of Vascular Access Including Arterial Superficialization with Mortality in Maintenance Hemodialysis Patients: A Nationwide Cohort Study in Japan.American journal of nephrology · 2023Article
- Shared decision-making in hemodialysis vascular access practice.Kidney international · 2021Review
- New Frontiers in Vascular Access Practice: From Standardized to Patient-tailored Care and Shared Decision Making.Kidney360 · 2021Review
- Influence of Tunneled Hemodialysis-Catheters on Inflammation and Mortality in Dialyzed Patients.International journal of environmental research and public health · 2021Article
- Outcomes of arteriovenous access among cancer patients requiring chronic haemodialysis.BMC nephrology · 2020Observational
3 more citing papers are in PubMed but not listed here.
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Whether placing a fistula first is the superior predialysis approach among octogenarians is unknown. We analyzed data from a cohort of 115,425 incident hemodialysis patients ≥67 years old derived from the US Renal Data System with linked Medicare claims, which allowed us to identify the first predialysis vascular access placed rather than the first access used. We used proportional hazard models to evaluate all-cause mortality outcomes based on first vascular access placed, considering the fistula group as the reference. In the study population, 21,436 patients had fistulas as the first predialysis access placed, 3472 had grafts, and 90,517 had catheters. Those patients with a catheter as the first predialysis access placed had significantly inferior survival compared with those patients with a fistula (HR=1.77; 95% CI=1.73 to 1.81; P<0.001). However, we did not detect a significant mortality difference between those patients with a graft as the first access placed and those patients with a fistula (HR=1.05; 95% CI=1.00 to 1.11; P=0.06). Analyzing mortality stratified by age groups, grafts as the first predialysis access placed had inferior mortality outcomes compared with fistulas for the 67 to ≤79-years age group (HR=1.10; 95% CI=1.02 to 1.17; P=0.007), but differences between these groups were not statistically significant for the 80 to ≤89- and the >90-years age groups. In conclusion, fistula first does not seem to be clearly superior to graft placement first in the elderly, because each strategy associates with similar mortality outcomes in octogenarians and nonagenarians.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.