SAN DIEGO—Patients with a failing kidney transplant are significantly less likely to receive vascular access surgery prior to starting hemodialysis (HD) than patients with advanced chronic kidney disease (CKD), even though they are younger and have a lower comorbidity burden, researchers reported at Kidney Week 2012.

Dalia Dawoud, MD, and collaborators at the University of Alabama in Birmingham compared vascular access management in two groups of patients who started HD during a five-year period: 123 with a failed renal transplant and 219 with advanced CKD.

The proportion of patients with pre-HD vascular access surgery was significantly lower in the failed transplant group than the CKD group (41% vs. 60%). This difference translated into a 31% decreased likelihood of vascular access surgery in the failed transplant group. The proportion of fistulas placed, however, was similar for failed transplant and CKD groups (70% and 75%, respectively).

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Furthermore, compared with the CKD patients initiating HD, those initiating HD after a failed transplant were younger, less likely to be black, and less likely to have diabetes or congestive heart failure.

The reason for the discrepancy, according to the investigators, is not known but may be due to a greater focus on salvaging the failing allograft at the expense of advanced vascular access planning.