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Optimal timing for vascular access creation.

Tamara K Jemcov1,2, Wim Van Biesen3

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Many end-stage renal disease (ESRD) patients start hemodialysis with central venous catheters (CVCs) instead of preferred arteriovenous fistulas (AVFs). Timely AVF creation requires better prediction models for patient suitability and surgical success.

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Medical Statistics

Background:

  • Guidelines recommend autologous arteriovenous fistulas (AVFs) for end-stage renal disease (ESRD) patients starting renal replacement therapy.
  • A significant number of ESRD patients initiate hemodialysis with central venous catheters (CVCs).
  • Challenges include AVF creation in patients who do not require dialysis or unsuccessful access attempts.

Purpose of the Study:

  • To promote timely AVF creation through preemptive assessment of patient suitability.
  • To address the lack of validated models for predicting AVF creation success.
  • To improve decision-making for vascular access in ESRD patients.

Main Methods:

  • Review of current guidelines and clinical practices for vascular access in ESRD.
  • Identification of existing prediction models for ESRD progression.
  • Highlighting the need for validated models to predict AVF success rates.

Main Results:

  • Current practices often deviate from AVF recommendations, with increased CVC use.
  • Existing prediction models aid in assessing ESRD progression but not AVF success.
  • Patient-specific factors and local surgical access influence AVF outcomes.

Conclusions:

  • Timely AVF creation requires improved preemptive assessment strategies.
  • Development of validated models to predict AVF success is crucial.
  • Shared decision-making between nephrology teams, patients, and surgeons, considering all factors, is essential for optimal vascular access planning.