ArticleJournal of the American Society of Nephrology : JASN2015
Vascular access choice in incident hemodialysis patients: a decision analysis.
Article in Journal of the American Society of Nephrology : JASN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it, 130 citations in OpenAlex.
- UK Kidney Association Clinical Practice Guideline on vascular access for haemodialysis.BMC nephrology · 2025Guideline
- Chinese experience on comparison of clinical efficacy and safety of hemodialysis and peritoneal dialysis in the treatment of diabetic kidney failure: a systematic review and meta-analysis.Frontiers in medicine · 2023Pooled 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
- The Potential of Sound Analysis to Reveal Hemodynamic Conditions of Arteriovenous Fistulae for Hemodialysis.Annals of biomedical engineering · 2025Trial
- Arteriovenous fistula creation with VasQThe journal of vascular access · 2024Trial
- The Role of High-Frequency Wall Vibrations in Adverse Vascular Remodeling of Arteriovenous Fistula for Hemodialysis.Kidney360 · 2026Article
- Clinical challenges and individualized approaches to dialysis therapy in older adults.The Korean journal of internal medicine · 2025Review
- Genetic versus self-reported African ancestry of the recipient and neighborhood predictors of kidney transplantation outcomes in 2 multiethnic urban cohorts.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024Article
- Endovascular creation of hemodialysis arteriovenous fistulae: the current status and future perspective-a literature review.Cardiovascular diagnosis and therapy · 2023Review
- Influence of Tunneled Hemodialysis-Catheters on Inflammation and Mortality in Dialyzed Patients.International journal of environmental research and public health · 2021Article
- A Korean perspective on the 2019 Kidney Disease Outcomes Quality Initiative guidelines for vascular access: what has changed and what should be changed in practice?Kidney research and clinical practice · 2021Article
- Arteriovenous Fistula Placement, Maturation, and Patency Loss in Older Patients Initiating Hemodialysis.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2020Article
- The Effect of Risk of Maturation Failure and Access Type on Arteriovenous Access-Related Costs among Hemodialysis Patients.Kidney360 · 2020Article
- Does Vascular Access Type Affect Access-Related Costs?Kidney360 · 2020Article
- The transition clinic in chronic kidney disease care.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2020Review
- Vascular access placement and mortality in elderly incident hemodialysis patients.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2020Article
- Association of Race and Ethnicity with Vascular Access Type Selection and Outcomes.Annals of vascular surgery · 2020Article
- Exploring Care Attributes of Nephrologists Ranking Favorably on Measures of Value.Journal of the American Society of Nephrology : JASN · 2019Article
- Initiation of maintenance hemodialysis through central venous catheters: study of patients' perceptions based on a structured questionnaire.BMC nephrology · 2019Article
- Comparison of Outcomes of Hybrid and Surgical Correction forVascular specialist international · 2018Article
Corrections and comments
- Commented on by
Authors and funding
6 authors at 4 institutions in 4 countries.
Funding
Abstract
Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.