{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T21:46:07Z","timestamp":1782510367937,"version":"3.54.5"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Optimal timing for arteriovenous fistula creation in chronic kidney disease is challenging. Late referral results in hemodialysis (HD) initiation via a central venous catheter (CVC), whereas early referral may lead to unnecessary procedures. We evaluate the predictive value of estimated glomerular filtration rate (eGFR) and the 2-Year Kidney Failure Risk Equation (KFRE) in forecasting HD initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Included adults referred for vascular mapping with \u2a7e3\u2009months of nephrology follow-up who selected HD as their preferred modality. The index date was the date of modality selection. We assessed HD initiation timing, vascular access (VA) type, mortality, and the predictive performance of eGFR and KFRE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Included 179 patients, of whom 43.6% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200978) and 58.7% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009105) initiated HD within 12 and 24\u2009months, respectively, with most (59.9%) starting via a CVC (59.9%). Within 24\u2009months, 6.7% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200912) died before HD initiation. Higher urinary protein-to-creatinine ratio, higher KFRE, lower eGFR, male sex, and heart failure with reduced ejection fraction were associated with increased HD risk. Predictive thresholds for HD initiation within 12\u2009months were eGFR &lt;17.1\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      (sensitivity: 77.9%, specificity: 54.1%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and KFRE &gt;32.8% (sensitivity: 75.6%, specificity: 68.3%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009\u2a7d\u20090.001). For 24\u2009months, thresholds were eGFR &lt;15.5\u2009mL\/min\/1.73\u2009m\n                      <jats:sup>2<\/jats:sup>\n                      (sensitivity: 56.7%, specificity: 73.2%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and KFRE &gt;31.0% (sensitivity: 71.4%, specificity: 71.6%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009\u2a7d\u20090.001). Patients exceeding the KFRE threshold had a higher risk of HD initiation than those below the eGFR threshold. A KFRE &gt;40.0% increased specificity, while lower thresholds (&gt;30%) improved sensitivity. Combining eGFR with KFRE enhance specificity but reduced sensitivity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>KFRE demonstrates superior predictive performance compared to eGFR for VA planning. Balancing different thresholds values and integrating KFRE with eGFR, can refine HD initiation risk assessment and VA referral, preventing unnecessary surgery and minimizing HD initiation via CVC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298251362913","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T04:33:38Z","timestamp":1754541218000},"page":"648-655","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk prediction for hemodialysis initiation: The role of Kidney Failure Risk Equation and personalized timely vascular access referral"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2294-573X","authenticated-orcid":false,"given":"Andreia","family":"Henriques","sequence":"first","affiliation":[{"name":"Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade de Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Venda","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade de Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Costa","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade da Regi\u00e3o de Leiria, Leiria, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Alves","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Sa\u00fade de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-21065-9"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-023-02608-9"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-022-00542-7"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08930816"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.02.001"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.12.001"},{"key":"e_1_3_2_8_2","first-page":"1","article-title":"Spanish clinical guidelines on vascular access for haemodialysis","author":"Ibeas J","year":"2017","unstructured":"Ibeas J, Roca-Tey R, Vallesp\u00edn J, et al. Spanish clinical guidelines on vascular access for haemodialysis. Nefrologia 2017; 37 Suppl 1: 1\u2013191.","journal-title":"Nefrologia"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2014090938"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2010.00783.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1129729819838132"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.4103\/1319-2442.308330"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.451"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07970718"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/1129729818786630"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/11297298221084799"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfae008"},{"key":"e_1_3_2_18_2","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2024","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024; 105: S117\u2013S314.","journal-title":"Kidney Int"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfae220"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae064"}],"container-title":["The Journal of Vascular Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11297298251362913","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11297298251362913","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11297298251362913","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:27:15Z","timestamp":1777692435000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11297298251362913"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1177\/11297298251362913"],"URL":"https:\/\/doi.org\/10.1177\/11297298251362913","relation":{},"ISSN":["1129-7298","1724-6032"],"issn-type":[{"value":"1129-7298","type":"print"},{"value":"1724-6032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]}}}