{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:57:56Z","timestamp":1789423076846,"version":"build-2803163510"},"reference-count":96,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":98,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Value\u2010based medicine (VBM) seeks to maximize patient\u2010relevant outcomes per unit cost. In end\u2010stage kidney disease (ESKD), vascular access (VA) is a dominant, modifiable driver of morbidity, mortality, and expenditure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a narrative review of published studies and gray literature on VA creation, maintenance, and salvage in ESKD, focusing on clinical outcomes, patient experience, and economic impact. Findings were synthesized within a VBM framework relevant to clinicians, health\u2010system leaders, and policymakers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Contemporary data confirm that tunneled dialysis catheters (TDCs) are associated with high rates of bloodstream infection, central venous injury, and mortality, and substantially higher costs than autogenous access. Arteriovenous fistulas (AVFs) offer the best long\u2010term value when creation is risk\u2010based, maturation is supported, and the access is actually used; nonmaturation, nonuse, and prolonged catheter dependence erode this advantage. Endovascular AVF and external support devices improve technical success and early patency but have uncertain cost\u2010effectiveness at current device prices. Arteriovenous grafts (AVGs) can provide greater net value than AVFs in selected patients (older, frail, or with poor veins) by shortening catheter exposure, at the expense of higher reintervention rates and maintenance costs. Across access types, circuit failure and recurrent interventions drive a substantial share of hemodialysis admissions and Medicare spending. Selective preoperative imaging, targeted duplex ultrasound in response to clinical findings, and ultrasound\u2010guided cannulation can improve access selection, maturation, and salvage while avoiding low\u2010value routine surveillance. Peritoneal dialysis remains underutilized despite comparable outcomes in many cohorts and lower average per\u2010patient costs than in\u2010center hemodialysis. Site\u2010of\u2010service optimization (office\u2010based\/ASC vs. hospital) and multidisciplinary, life\u2010plan\u2010based access programs further reduce admissions, catheter days, and per\u2010patient costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A value\u2010based VA strategy for ESKD should prioritize minimizing catheter exposure, tailoring AVF versus AVG use to patient risk, integrating PD where feasible, using selective imaging and monitoring, matching site of service to case complexity, and organizing multidisciplinary access teams aligned with quality and cost metrics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/sdi.70024","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T05:05:49Z","timestamp":1775797549000},"page":"15-25","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Value\u2010Based Model for Vascular Access Management in the End\u2010Stage Kidney Disease Population"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3584-3748","authenticated-orcid":false,"given":"Daniel","family":"Raskin","sequence":"first","affiliation":[{"name":"Interventional Radiology Division Cleveland Clinic  Cleveland Ohio USA"},{"name":"Vascular Surgery, Heart, Vascular and Thoracic Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tushar\u00a0J.","family":"Vachharajani","sequence":"additional","affiliation":[{"name":"Department of Medicine John D Dingell Veterans Affairs Medical Centre  Detroit Michigan USA"},{"name":"Wayne State University School of Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasan","family":"Partovi","sequence":"additional","affiliation":[{"name":"Interventional Radiology Division Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Khan","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Heart, Vascular and Thoracic Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean\u00a0P.","family":"Lyden","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Heart, Vascular and Thoracic Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levester","family":"Kirksey","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Heart, Vascular and Thoracic Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.27.3.759"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2017.09.018"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2021.01.019"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1542329"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1526482"},{"key":"e_1_2_11_7_1","volume-title":"National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health","author":"United States Renal Data System","year":"2025"},{"key":"e_1_2_11_8_1","volume-title":"Origins of the Medicare Kidney Disease Entitlement: The Social Security Amendments of 1972","author":"Rettig R. 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