April 17, 2026
2 min read
Key takeaways:
- At the time of hemodialysis initiation, more than half of patients had an arteriovenous fistula.
- Fistula use rates reached 90% in 3 years.
One-third of older patients with end-stage kidney disease received an arteriovenous fistula within 6 months of starting hemodialysis, according to study data published in Kidney360.
Among patients who received an arteriovenous fistula (AVF), 90% eventually used that access for hemodialysis, according to researchers.
Arteriovenous fistula creation for older patients with ESKD was considered on time for 32% of patients. Image: Adobe Stock
AVFs are considered the preferred vascular access option, but determining the appropriate time to create an AVF can be difficult, according to Boudewijn Heggen, MD, of the department of vascular surgery at Maastricht University Medical Center in the Netherlands, and colleagues.
If created too early, AVFs may go unused and increase risks for complications like hand ischemia, according to the researchers. If an AVF is created too late, patients may receive a central venous catheter (CVC) instead to start hemodialysis, which is associated with increased mortality and bloodstream infection, the researchers wrote.
“With the ageing population and rising numbers of elderly patients starting dialysis, understanding optimal timing of AVF creation has become increasingly urgent,” Heggen and colleagues wrote.
In a prospective observational study, the researchers evaluated trends in timing of vascular access creation with autologous AVF and CVC among 332 patients aged at least 65 years with ESKD (mean age, 76 years; 77% men) in the European EQUAL cohort study between 2013 and 2023.
Vascular access timing was classified under three categories:
- early: hemodialysis not initiated within 6 months after AVF creation;
- on time: hemodialysis initiated within 6 months of AVF creation; or
- late: hemodialysis initiated with CVC within 6 months after AVF creation or initiated with CVC before AVF creation.
Results showed 67% of patients received AVFs as their first vascular access. Among the 33% of patients who received a CVC, nearly half received an AVF afterward.
At the time of hemodialysis initiation, 54% had an AVF and 46% had a CVC.
AVF creation was considered early for 42% of patients, on time for 32% of patients and late for 26% of patients.
Notably, 90% of patients with AVFs began receiving hemodialysis within 3 years, indicating high fistula use rates, according to the researchers.
Overall, the findings suggest most older patients eventually used their AVF for hemodialysis, according to the researchers. However, the potential for unused AVFs and vascular access complications indicate more research is needed to inform vascular access practices, they wrote.
“These findings may aid in discussing vascular access options with elderly patients and indicate the need to develop a clinical prediction tool for imminent hemodialysis initiation to guide the timing of vascular access surgery,” the researchers wrote.
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