Evidence map›Paper›PMID 25568219›Full record

Observational studyClinical journal of the American Society of Nephrology : CJASN2015

Vascular access creation before hemodialysis initiation and use: a population-based cohort study.

Ahmed A Al-Jaishi, Charmaine E Lok, Amit X Garg, Joyce C Zhang, Louise M Moist

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Clinical journal of the American Society of Nephrology : CJASN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Article
  6. Review
  7. Are There Differences in Arteriovenous Fistulae Created for Hemodialysis between Nephrologists and Vascular Surgeons?Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2021
    Article
  8. 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 · 2020
    Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Arteriovenous fistula creation may slow estimated glomerular filtration rate trajectory.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2015
    Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Ahmed A Al-JaishiInstitute for Clinical Evaluative Sciences, Kidney Dialysis Transplantation Program, Toronto, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada;
Charmaine E LokInstitute for Clinical Evaluative Sciences, Kidney Dialysis Transplantation Program, Toronto, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
Amit X GargInstitute for Clinical Evaluative Sciences, Kidney Dialysis Transplantation Program, Toronto, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and.
Joyce C ZhangKidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and.
Louise M MoistKidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and louise.moist@lhsc.on.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesIn Canada, approximately 17% of patients use an arteriovenous access (fistula or arteriovenous graft) at commencement of hemodialysis, despite guideline recommendations promoting its timely creation and use. It is unclear if this low pattern of use is attributable to the lack of surgical creation or a high nonuse rate. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using large health care databases in Ontario, Canada, a population-based cohort of adult patients (≥18 years old) who initiated hemodialysis as their first form of RRT between 2001 and 2010 was studied. The aims were to (1) estimate the proportion of patients who had an arteriovenous access created before starting hemodialysis and the proportion who successfully used it at hemodialysis start, (2) test for secular trends in arteriovenous access creation, and (3) estimate the effect of late nephrology referral and patient characteristics on arteriovenous access creation.

resultsThere were 17,183 patients on incident hemodialysis. The mean age was 65.8 years, 60% were men, and 40% were referred late to a nephrologist; 27% of patients (4556 of 17,183) had one or more arteriovenous accesses created, and the median time between arteriovenous access creation and hemodialysis start was 184 days. When late referrals were excluded, 39% of patients (4007 of 10,291) had one or more arteriovenous accesses created, and 27% of patients (2724 of 10,291) used the arteriovenous access. Since 2001, there has been a decline in arteriovenous access creation before hemodialysis initiation. Women, higher numbers of comorbidities, and rural residence were consistently associated with lower rates of arteriovenous access creation. These results persisted even after removing patients with <6 months nephrology care or who had AKI 6 months before starting hemodialysis.

conclusionsIn Canada, arteriovenous access creation before hemodialysis initiation is low, even among patients followed by a nephrologist. Better understanding of the barriers and influencers of arteriovenous access creation is needed to inform both clinical care and guidelines.

Indexed as

AgedAged, 80 and overArteriovenous Shunt, SurgicalComorbidityFemaleGuideline AdherenceHumansKidney Failure, ChronicMaleMiddle AgedNephrologyOntarioPractice Guidelines as TopicPractice Patterns, Physicians'Referral and ConsultationRenal Dialysisarteriovenous accessepidemiology and outcomeshemodialysishemodialysis accessvascular access

Identifiers

PMID25568219
PMCPMC4348683

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.