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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Current knowledge about how preemptive arteriovenous (AV) fistula creation has been implemented is mostly based on information obtained retrospectively from patients who have initiated hemodialysis (HD). There is also a lack of evidence on patient outcomes following AV access creation, especially HD competing risks (e.g., death prior to HD initiation). Our study’s aims were to describe international variations in practice patterns of preemptive AV fistula creation, and to assess patient outcomes following this creation.
We used data spanning from 2013 to 2020 from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). Patients with moderate to advanced CKD followed in nephrology clinics were enrolled in Brazil (865), France (3033), Japan (2249) and the United States (2501). First, we compared patterns of preemptive AV fistula creation across countries —based on the first-ever AV access created — with regard to patients’ characteristics, anatomical site, and timing of creation (i.e., eGFR and 2-year kidney failure risk estimated with the 4-variable KFRE). Then, we used cumulative incidence functions to estimate the 2-year probabilities of HD initiation, death, and initiation of another KRT modality.
From the original cohorts, we identified 43, 401, 560 and 93 patients who underwent a first preemptive AV fistula creation during the study follow-up in Brazil, France, Japan and the United States (US), respectively. Median age ranged from 64 to 70 years and was the lowest in the Brazilian cohort. The prevalence of diabetes ranged from 40% to 65%, and that of cardiovascular comorbidity, from 27% to 41%, both being the lowest in the Japanese cohort. AV fistula was created in the upper arm in 44% of patients in the US, 28% in Brazil, 24% in France and 2% in Japan, at a median eGFR of 12 to 13 ml/min/1.73 m2, except in Japan where the median eGFR was substantially lower, of 7 ml/min/1.73 m2 (corresponding to a median predicted 2-year kidney failure risk of 66%). The observed 2-year probability of HD initiation following preemptive AV fistula creation was the highest among patients in Japan (96%), followed by those in France (74%) and in the US (65%, Figure); the 2-year probability of individual competing risks were < 10% in all cohorts.
Practices of preemptive AV fistula creation varied substantially across international cohorts. The risks of death or initiation of an alternative KRT modality following preemptive AV fistula creation were generally low. However, when considered alongside the probability of not requiring HD within a 2-year horizon, these risks resulted in a non-negligible rate of untimely fistula creation, even when the eGFR at the time of creation was consistent with international guidelines.
