title: Willingness to participate in a randomized trial comparing catheters to fistulas for vascular access in incident hemodialysis patients: an international survey of nephrologists.
abstract: BACKGROUND
  Current guidelines favor fistulas over catheters as vascular access. Yet, the observational literature comparing fistulas to catheters has important limitations and biases that may be difficult to overcome in the absence of randomization. However, it is not clear if physicians would be willing to participate in a clinical trial comparing fistulas to catheters.
  
  
  OBJECTIVE
  We also sought to elicit participants' opinions on willingness to participate in a future trial regarding catheters and fistulas.
  
  
  METHODS
  We created a three-part survey consisting of 19 questions. We collected demographic information, respondents' knowledge of the vascular access literature, appropriateness of current guideline recommendations, and their willingness to participate in a future trial.
  
  
  METHODS
  Participants were recruited from Canada, Europe, Australia, and New Zealand.
  
  
  METHODS
  Participants include physicians and trainees who are involved in the care of end-stage renal disease patients requiring vascular access.
  
  
  METHODS
  Descriptive statistics were used to describe baseline characteristics of respondents according to geographic location. We used logistic regression to model willingness to participate in a future trial.
  
  
  METHODS
  We surveyed nephrologists from Canada, Europe, Australia, and New Zealand to assess their willingness to participate in a randomized trial comparing fistulas to catheters in incident hemodialysis patients.
  
  
  RESULTS
  Our results show that in Canada, 86 % of respondents were willing to participate in a trial (32 % in all patients; 54 % only in patients at high risk of primary failure). In Europe and Australia/New Zealand, the willingness to participate in a trial that included all patients was lower (28 % in Europe; 25 % in Australia/New Zealand), as was a trial that included patients at high risk of primary failure (38 % in Europe; 39 % in Australia/New Zealand). Nephrologists who have been in practice for a few years, saw a larger volume of patients, or self-identified as experts in vascular access literature were more likely to participate in a trial.
  
  
  CONCLUSIONS
  Survey distribution was limited to vascular access experts in participating European countries and ultimately led to a discrepancy in numbers of European to non-European respondents overall. Canadian views are likely over-represented in the overall outcomes.
  
  
  CONCLUSIONS
  Our survey results suggest that nephrologists believe there is equipoise surrounding the optimal vascular access strategy and that a randomized controlled study should be undertaken, but restricted to those individuals with a high risk of primary fistula failure.
authors.affiliation: Internal Medicine, University of Calgary, Calgary, Canada.
authors.forename: Krishna
authors.initials: K
authors.lastname: Poinen
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Canada ; Foothills Medical Centre, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Institute of Population Health, Health e-Research Centre, University of Manchester, Manchester, UK.
authors.forename: Sabine N
authors.initials: SN
authors.lastname: Van der Veer
authors.affiliation: Department Medical Informatics, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: UZ Gent, Dienst Nefrologie, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.affiliation: Monash Medical Centre, Melbourne, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: Australian and New Zealand Society of Nephrology, Melbourne, Australia.
authors.forename: Aviva
authors.initials: A
authors.lastname: Rosenfeld
authors.affiliation: Medicine, University of Calgary, Calgary, Canada.
authors.forename: Adriane M
authors.initials: AM
authors.lastname: Lewin
authors.affiliation: Medicine, University of Calgary, Calgary, Canada.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Dulai
authors.affiliation: Medicine and Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
keywords: CKD; Catheters; Chronic renal failure; Dialysis; ESRD; Fistulas; Hemodialysis; Vascular access