In this study We examined the association between attempted arteriovenous fistula (AVF) creation in patients already receiving hemodialysis via a central venous catheter (CVC) and mortality. We hypothesized that attempting AVF creation (regardless of whether the AVF later became usable) in these patients would be associated with lower mortality. We used a marginal structural model to determine the association between attempted AVF creation and death after accounting for confounding and immortal-time bias (the period of follow-up during which death cannot occur because of the study design). Those who had undergone an attempt at AVF creation were younger and had had fewer comorbidities and a lower glomerular filtration rate, had less often started dialysis as an inpatient, and had more often received predialysis care (Table). In a marginal structural model controlling for differences in age, gender, duration of predialysis care, and a history of diabetes or cardiovascular disease, attempted AVF creation was associated with significantly lower mortality (hazard ratio, 0.53; 95% confidence interval, 0.43-0.65). This effect did not appear to be mediated by differences in the frequency of hospitalizations or subsequent procedures and remained robust in sensitivity analyses accounting for differences in between-group follow-up.

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