{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:17:25Z","timestamp":1778156245979,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"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":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Timely vascular access creation in end-stage kidney disease is critical for optimizing patient outcomes. While early nephrology referral (\u2a7e90\u2009days pre-dialysis) improves access patency and survival, late referral is associated with worse outcomes. Healthcare system structure and demographics may impact vascular access strategies. This study compared late-referral hemodialysis patients from two high-volume hospitals in different healthcare systems, focusing on vascular access and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective, two-center study included 463 late-referral hemodialysis patients (mean age 60.4\u2009\u00b1\u200915.8\u2009years; 63.3% male) initiating dialysis with a tunneled CVC between January 2020 and May 2024 at King\u2019s College Hospital, London (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009249) and Policlinico A. Gemelli, Rome (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009214). Primary outcome: all-cause mortality. Secondary outcomes: AVF creation, primary and secondary AVF patency, and CRBSI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      AVF recipients had significantly lower mortality than non-AVF patients (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.002), and a lower bacteremia rate (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.05) across both Italy and UK cohorts (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.005 and\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0005, respectively). Time to AVF creation was significantly associated with mortality (OR 1.003; 95% CI 1.000\u20131.006;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.02). AVF creation was achieved in 42.1% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009195), with primary patency rate of 62.7% at 6\u2009months. Ethnicity (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.01) and age (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0004) influenced AVF type selection. Among non-AVF patients, 26% declined surgery despite eligibility, showing reduced survival (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.03). CRBSIs occurred in 16% of patients, mostly Gram-positive (70.3%). Relapse rate was higher with CVC removal\/replacement than guidewire exchange (19.4% vs 0%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Early AVF creation in late-referral hemodialysis patients improves survival and reduces CRBSI risk. Reducing CVC requirement, especially in AVF-eligible patients, is a key strategy to improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298251390107","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:43:07Z","timestamp":1762756987000},"page":"1162-1170","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Timely AVF creation in late-referral hemodialysis patients, a two-cohort study: Too late to plan, not too late to act"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6808-3598","authenticated-orcid":false,"given":"Elettra","family":"Lomeo","sequence":"first","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Mangiacapra","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca Maria","family":"D\u2019Ascenzo","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raghvinder Pal Singh","family":"Gambhir","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitta","family":"Nivedita","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Grandaliano","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"Department of Translational Medicine and Surgery, Universita\u2019 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Valenti","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Pesce","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and Surgery, Universita\u2019 Cattolica del Sacro Cuore, Rome, Italy"},{"name":"Division of Renal Medicine, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.14745"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2021.05.031"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2011.368"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019030274"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.12.001"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-024-03593-z"},{"issue":"1","key":"e_1_3_3_8_2","article-title":"[The management of arteriovenous fistula for dialysis patients]","volume":"31","author":"Lopez T","year":"2014","unstructured":"Lopez T, Casino F. 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