title: Hemodialysis Arteriovenous Vascular Access Creation After Kidney Transplant Failure.
abstract: BACKGROUND
  Little is known about vascular access in patients starting hemodialysis therapy after kidney transplant failure.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Adult patients (aged ≥18 years) who started hemodialysis therapy in Ontario, Canada, from January 1, 2001, through December 31, 2010, after kidney transplant failure.
  
  
  METHODS
  Patient clinical and demographic characteristics.
  
  
  RESULTS
  Proportion and timing of arteriovenous (AV) vascular access creation (fistula or graft) 12 months prior and up to 24 months after starting hemodialysis therapy.
  
  
  METHODS
  Event rates and outcome predictors.
  
  
  RESULTS
  Our cohort included 683 patients with a mean age of 48 years and >50% with comorbidity index score < 3. In the 12 months predialysis and 24 months postdialysis, 16% and 47% of patients had an AV access created, respectively. In the postdialysis period, 13%, 26%, and 38% of patients had an AV access creation at 3, 6, and 12 months, respectively. History of coronary artery disease, diabetes mellitus, and peritoneal dialysis use prior to transplantation were associated with a lower likelihood of AV access creation.
  
  
  CONCLUSIONS
  Residual selection bias from unmeasured variables beyond the data elements.
  
  
  CONCLUSIONS
  In Ontario, AV access creation, both before and after starting hemodialysis therapy, is low in patients with kidney transplant failure despite their being younger and healthier compared to the overall hemodialysis population. This highlights the need for a predialysis care pathway in the transplantation clinic and an active strategy to identify this patient cohort receiving hemodialysis to align modality and access choices.
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Zhang
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Jaishi
authors.affiliation: Division of Nephrology, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Perl
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: louise.moist@lhsc.on.ca.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fistula First; Renal failure; arteriovenous fistula (AVF); arteriovenous graft (AVG); catheter; chronic kidney disease (CKD); fistula creation; hemodialysis; modality change; predialysis care; renal replacement therapy (RRT); transplant failure; vascular access