Clinical Research Directory

Inclusion Criteria: 1. Adult patients aged 65 years or older 2. End-stage renal disease with unlikely recovery of kidney function according to the attending nephrologist 3. Hemodialysis is the intended long-term modality of treatment for end-stage renal disease 4. Fit for vascular access surgery as determined by the local multidisciplinary vascular access team 5a. Expected to start hemodialysis treatment within 6 months at the time of treatment assignment; or 5b. Treated with hemodialysis for 6 months or less at the time of treatment assignment using a tunneled or non-tunneled central venous catheter for vascular access 6\. Planning to remain in one of participating dialysis centers for at least 1 year 7. Suitable vascular anatomy for all types of vascular access based on duplex ultrasound of the arms, defined as: * at least one suitable configuration for an arteriovenous fistula using minimal arterial and venous diameters of 2mm for radiocephalic fistulas and 3mm for brachiocephalic and brachiobasilic fistulas; * at least one suitable configuration for an arteriovenous graft using minimal arterial and venous diameters of 3mm and 4mm, respectively; and * at least one open internal jugular vein for a central venous catheter. Exclusion Criteria: 1. Patent arteriovenous fistula or graft already in place 2. Prior unsuccessful arteriovenous fistula or graft vascular access surgery 3. Kidney transplantation planned within 6 months 4. Metastatic malignancies or other condition associated with a life expectancy of \<6 months, in the opinion of the attending nephrologist 5. Unable to provide informed consent 6. Dusseux risk score \<5, indicating an usually long life expectancy for elderly patients starting hemodialysis treatment (the Dusseux risk score was adapted for patients between 65 and 70 years by assigning -3 points to this age category)