title: Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?
abstract: BACKGROUND
  Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation.
  
  
  METHODS
  All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed.
  
  
  RESULTS
  Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR &lt;15 mL/min at six months while 21/34 (61%) had eGFR &lt;15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p&lt;0.0001).
  
  
  CONCLUSIONS
  Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Naveed Ul
authors.initials: NU
authors.lastname: Haq
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.|Nephrology Unit, Department of Internal Medicine, Alexandria University, Alexandria - Egypt.
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Abdelsalam
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Mohammed Mahdi
authors.initials: MM
authors.lastname: Althaf
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Abdulrahman Ali
authors.initials: AA
authors.lastname: Khormi
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al Harbi
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Bader
authors.initials: B
authors.lastname: Alshamsan
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Mamdouh Nasser
authors.initials: MN
authors.lastname: Albaqumi
authors.affiliation: Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Dieter Clemens
authors.initials: DC
authors.lastname: Broering
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Lutfi
authors.initials: L
authors.lastname: Alkorbi
authors.affiliation: Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh - Kingdom of Saudi Arabia.
authors.forename: Hassan Ali
authors.initials: HA
authors.lastname: Aleid
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D000072104:Nephrologists; D009398:Nephrology / Q000379:methods*; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult