Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
    • Reprint Information
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Reprint Information
    • Subscriptions
    • Feedback
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum
In-Depth Reviews
You have accessRestricted Access

Dialysis Fistula or Graft: The Role for Randomized Clinical Trials

Michael Allon and Charmaine E. Lok
CJASN December 2010, 5 (12) 2348-2354; DOI: https://doi.org/10.2215/CJN.06050710
Michael Allon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charmaine E. Lok
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data Supps
  • Info & Metrics
  • View PDF
Loading

Abstract

The Fistula First Initiative has strongly encouraged nephrologists, vascular access surgeons, and dialysis units in the United States to make valiant efforts to increase fistula use in the hemodialysis population. Unfortunately, the rigid “fistula first” recommendations are not based on solid, current, evidence-based data and may be harmful to some hemodialysis patients by subjecting them to prolonged catheter dependence with its attendant risks of bacteremia and central vein stenosis. Once they are successfully cannulated for dialysis, fistulas last longer than grafts and require fewer interventions to maintain long-term patency for dialysis. However, fistulas have a much higher primary failure rate than grafts, require more interventions to achieve maturation, and entail longer catheter dependence, thereby leading to more catheter-related complications. Given the tradeoffs between fistulas and grafts, there is equipoise about their relative merits in patients with moderate to high risk of fistula nonmaturation. The time is right for definitive, large, multicenter randomized clinical trials to compare fistulas and grafts in various subsets of chronic kidney disease patients. Until the results of such clinical trials are known, the optimal vascular access for a given patients should be determined by the nephrologist and access surgeon by taking into account (1) whether dialysis has been initiated, (2) the patient's life expectancy, (3) whether the patient has had a previous failed vascular access, and (4) the likelihood of fistula nonmaturation. Careful clinical judgment should optimize vascular access outcomes and minimize prolonged catheter dependence among hemodialysis patients.

Footnotes

    • Copyright © 2010 by the American Society of Nephrology
    View Full Text
    PreviousNext
    Back to top

    In this issue

    Clinical Journal of the American Society of Nephrology
    Vol. 5, Issue 12
    1 Dec 2010
    • Table of Contents
    • Table of Contents (PDF)
    • Index by author
    View Selected Citations (0)
    Print
    Download PDF
    Sign up for Alerts
    Email Article
    Thank you for your help in sharing the high-quality science in CJASN.
    Enter multiple addresses on separate lines or separate them with commas.
    Dialysis Fistula or Graft: The Role for Randomized Clinical Trials
    (Your Name) has sent you a message from American Society of Nephrology
    (Your Name) thought you would like to see the American Society of Nephrology web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    Dialysis Fistula or Graft: The Role for Randomized Clinical Trials
    Michael Allon, Charmaine E. Lok
    CJASN Dec 2010, 5 (12) 2348-2354; DOI: 10.2215/CJN.06050710

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Request Permissions
    Share
    Dialysis Fistula or Graft: The Role for Randomized Clinical Trials
    Michael Allon, Charmaine E. Lok
    CJASN Dec 2010, 5 (12) 2348-2354; DOI: 10.2215/CJN.06050710
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like

    Jump to section

    • Article
      • Abstract
      • Disclosures
      • Footnotes
      • References
    • Figures & Data Supps
    • Info & Metrics
    • View PDF

    More in this TOC Section

    • Assessing Physical Function and Physical Activity in Patients with CKD
    • Effect of Red Cell Transfusions on Future Kidney Transplantation
    • Management of Crush Victims in Mass Disasters: Highlights from Recently Published Recommendations
    Show more In-Depth Reviews

    Cited By...

    • Vascular Access for Hemodialysis Patients: New Data Should Guide Decision Making
    • Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study
    • Vascular Access Type and Clinical Outcomes among Elderly Patients on Hemodialysis
    • A completely biological "off-the-shelf" arteriovenous graft that recellularizes in baboons
    • Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis
    • Reassessing Recommendations for Choice of Vascular Access
    • New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?
    • New Insights into Dialysis Vascular Access: Introduction
    • Peritoneal Dialysis Adequacy in Elderly Patients
    • Vascular Access Creation before Hemodialysis Initiation and Use: A Population-Based Cohort Study
    • Catheter Last, Fistula Not-So-First
    • Vascular Access Choice in Incident Hemodialysis Patients: A Decision Analysis
    • Initial Vascular Access Type in Patients with a Failed Renal Transplant
    • Re-envisioning Fistula First in a Patient-Centered Culture
    • Cumulative Patency of Contemporary Fistulas versus Grafts (2000-2010)
    • Lifting the Veil: Insights into Vascular Access Options
    • Outcomes of Arteriovenous Fistula Creation after the Fistula First Initiative
    • Google Scholar

    Similar Articles

    Related Articles

    • No related articles found.
    • PubMed
    • Google Scholar

    Articles

    • Current Issue
    • Early Access
    • Subject Collections
    • Article Archive
    • ASN Meeting Abstracts

    Information for Authors

    • Submit a Manuscript
    • Trainee of the Year
    • Author Resources
    • ASN Journal Policies
    • Reuse/Reprint Policy

    About

    • CJASN
    • ASN
    • ASN Journals
    • ASN Kidney News

    Journal Information

    • About CJASN
    • CJASN Email Alerts
    • CJASN Key Impact Information
    • CJASN Podcasts
    • CJASN RSS Feeds
    • Editorial Board

    More Information

    • Advertise
    • ASN Podcasts
    • ASN Publications
    • Become an ASN Member
    • Feedback
    • Follow on Twitter
    • Password/Email Address Changes
    • Subscribe

    © 2021 American Society of Nephrology

    Print ISSN - 1555-9041 Online ISSN - 1555-905X

    Powered by HighWire