The Arteriovenous Vascular (AV) ACCESS Trial

Inclusion Criteria:

• Age 60 years or older

• End-stage kidney disease on hemodialysis via a central venous catheter

• Hemodialysis is the long-term modality of treatment for end-stage kidney disease

• Central venous catheter is the sole vascular access used for hemodialysis at thetime of referral for arteriovenous access creation

• Referred by patient's nephrologist for placement of arteriovenous access

• At least one of the following comorbid conditions: cardiovascular disease,peripheral vascular disease, and/or diabetes mellitus

• Medically and surgically eligible to undergo surgical placement of an arteriovenousaccess, deemed by the treating healthcare providers

• Native vasculature deemed preoperatively to be suitable for surgical creation ofeither type of arteriovenous access (arteriovenous fistula or arteriovenous graft)in the opinion of the surgeon

• Patient agreed to study participation and signed the informed consent

Exclusion Criteria:

• Severe cardiac disease defined as presence of either of the following threeconditions: congestive heart failure with ejection fraction ≤ 20%, heart transplant,or ventricular assist device

• Known or suspected central vein stenosis or vascular obstruction on the side ofplanned study access creation, unless corrected prior to randomization

• Planned arteriovenous fistula creation by means other than suture or vascularanastomotic clips (e.g. endovascular surgery or other anastomotic creation devices)

• Anticipated kidney transplant within 12 months

• Anticipated conversion to peritoneal dialysis within 12 months

• Anticipated transfer of nephrology care to a clinic outside the study participatingcenters within 12 months

• Anticipated non-compliance with medical care based on physician judgment

• A condition in which, in the opinion of the site PI renders the patient not a goodcandidate for study participation.