Observational studyJournal of the American Society of Nephrology : JASN2017
The Survival Benefit of "Fistula First, Catheter Last" in Hemodialysis Is Primarily Due to Patient Factors.
Observational study in Journal of the American Society of Nephrology : JASN, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 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.
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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.
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Who cites it
54 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- UK Kidney Association Clinical Practice Guideline on vascular access for haemodialysis.BMC nephrology · 2025Guideline
- 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
- ACCESS HD pilot: A randomised feasibility trial Comparing Catheters with fistulas in Elderly patientS Starting haemodialysis.BMJ open · 2016Trial
- 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
- Vascular Access Surgery Timing: A Prospective European Cohort Study in Elderly Patients with ESKD.Kidney360 · 2026Observational
- Preemptive Vascular Access Placement and Mortality Risk in Hemodialysis Patients: A Real-World Single-Center Study.Hemodialysis international. International Symposium on Home Hemodialysis · 2026Article
- Vascular Access Management in Patients on Catheter-Based Hemodialysis.Journal of clinical medicine · 2026Article
- More than a Last Resort: The Role of Tunneled Catheters in Hemodialysis.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- Programmable Compliance in Small-Diameter Vascular Grafts by Design of Melt-Electrowritten Scaffold Architectures for In Situ Tissue Engineering.Advanced healthcare materials · 2026Article
- Patterns and outcomes of vascular access in hemodialysis: a nationwide registry-based study from Romania.Renal failure · 2025Article
- The Rate of Procedures Required to Maintain Hemodialysis Vascular Access: A Data Linkage Analysis.Kidney360 · 2025Article
- Epidemiology of Vascular Access in Patients Undergoing Chronic Hemodialysis Treatment in Greece.Journal of clinical medicine · 2025Article
- Vascular Access Type and Survival Outcomes in Hemodialysis Patients: A Seven-Year Cohort Study.Medicina (Kaunas, Lithuania) · 2025Article
- Vascular Access for Home Hemodialysis: A Perspective on Tunneled Central Venous Catheters at Home.Kidney medicine · 2025Review
- Vascular access type and prognosis in elderly hemodialysis patients: a propensity-score-matched study.Renal failure · 2024Article
- Left superior vena cava's unconventional path to left atrium drainage: A case report.Radiology case reports · 2024Article
- A decade of arteriovenous fistula creations in the ⩾75 years population: Equal opportunity or sub-optimal use of resources.The journal of vascular access · 2024Article
- A Modified Switching Procedure from Temporary to Tunneled Central Venous Dialysis Catheters.Journal of clinical medicine · 2024Article
- Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas.BMC nephrology · 2024Article
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Funding
No grant is acknowledged in the PubMed record.
Abstract
Patients needing hemodialysis are advised to have arteriovenous fistulas rather than catheters because of significantly lower mortality rates. However, disparities in fistula placement raise the possibility that patient factors have a role in this apparent mortality benefit. We derived a cohort of 115,425 patients on incident hemodialysis ≥67 years old from the US Renal Data System with linked Medicare claims to identify the first predialysis vascular access placed. We compared mortality outcomes in patients initiating hemodialysis with a fistula placed first, a catheter after a fistula placed first failed, or a catheter placed first (n=90,517; reference group). Of 21,436 patients with a fistula placed first, 9794 initiated hemodialysis with that fistula, and 8230 initiated dialysis with a catheter after failed fistula placement. The fistula group had the lowest mortality over 58 months (hazard ratio, 0.50; 95% confidence interval, 0.48 to 0.52; P<0.001), with mortality rates at 6, 12, and 24 months after initiation of 9%, 17%, and 31%, respectively, compared with 32%, 46%, and 62%, respectively, in the catheter group. However, the group initiating hemodialysis with a catheter after failed fistula placement also had significantly lower mortality rates than the catheter group had over 58 months (hazard ratio, 0.66; 95% confidence interval, 0.64 to 0.68; P<0.001), with mortality rates of 15%, 25%, and 42% at 6, 12, and 24 months, respectively. Thus, patient factors affecting fistula placement, even when patients are hemodialyzed with a catheter instead, may explain at least two thirds of the mortality benefit observed in patients with a fistula.
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