Observational studyKidney3602026
Vascular Access Surgery Timing: A Prospective European Cohort Study in Elderly Patients with ESKD.
Observational study in Kidney360, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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Who cites it
1 citing paper in PubMed.
- Vascular Access in Older Adults Approaching Kidney Failure: Is There a Single Right Time?Kidney360 · 2026Article
Corrections and comments
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Authors and funding
18 authors.
Funding
Abstract
key pointsOnly 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.
backgroundTiming 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.
methodsThis 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).
resultsA 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.
conclusionsOnly 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.
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