End-stage renal disease
Conditions
Interventions
1. Arteriovenous graft implantation
2. Central venous catheter placement
3. Autologous arteriovenous fistula creation (recommended by current guidelines)
Sponsors
Academisch Ziekenhuis Maastricht
Eligibility
Inclusion criteria
Inclusion criteria: 1. Adult patients aged 70 years or older; 2. End-stage renal disease with unlikely recovery of kidney function according to the at-tending nephrologist; 3. Hemodialysis is the intended long-term modality of treatment for end-stage renal dis-ease; 4. Fit for vascular access surgery as determined by the local multidisciplinary vascular access team; 5. A. Expected to start hemodialysis treatment within 6 months at the time of treatment assignment; or B. Treated with hemodialysis for 6 months or less at the time of treatment assignment using a tunneled or non-tunneled central venous catheter for vascular access; 6. Planning to remain in one of participating dialysis centers for at least 1 year; 7. Suitable vascular anatomy for all types of vascular access based on duplex ultrasound of the arms, defined as: • at least one suitable configuration for an arteriovenous fistula using minimal arterial and venous diameters of 2mm for radiocephalic fistulas and 3mm for brachiocephalic and brachiobasilic fistulas; • at least one suitable configuration for an arteriovenous graft using minimal arterial and venous diameters of 3mm and 4mm, respectively; and • at least one open internal jugular vein for a central venous catheter.
Exclusion criteria
Exclusion criteria: 1. Patent arteriovenous fistula or graft already in place; 2. Prior unsuccessful arteriovenous fistula or graft vascular access surgery; 3. Kidney transplantation planned within 6 months; 4. Metastatic malignancies or other condition associated with a life expectancy of <6 months, in the opinion of the attending nephrologist; 5. Unable to provide informed consent; 6. Dusseux risk score <5, indicating an unusually long life expectancy for elderly patients starting hemodialysis treatment
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The number of access-related interventions required for each person-year of hemodialysis treatment | — |
Secondary
| Measure | Time frame |
|---|---|
| Patient-reported outcome measures (SF-12 / DSI measured every 3 months and SF-VAQ measured every month until the latest of one year of follow-up or one year of dialysis treatment has been reached), health care costs, access-related complications, days in hospital, and mortality | — |
Contacts
Public ContactMaarten Snoeijs
Maastricht UMC+
Outcome results
None listed