Therefore, initiation of dialysis with a CVC should be avoided as much as possible. On the other hand, occlusion or failure of an arteriovenous fistula (AVF) or a graft (AVG) subsequently leads to the use of a CVC. It has been reported that the timing of the

first puncture after placement of an AVF or AVG was associated with the patency of access. Therefore, we deduced that AZD6244 in vivo the timing of the first cannulation at a time when access patency is maximized can influence survival. Several studies have Fosbretabulin mouse investigated the relationship between the timing of the first puncture and subsequent access patency. Their results have shown that patients who started their hemodialysis treatment either within 14 or 30 days after the creation of an AVF experienced a higher incidence of access failure. Moreover, a beneficial effect of AVF or AVG at the initiation of hemodialysis LGX818 chemical structure was also demonstrated from an economic view point; the population of patients

with functioning access at the start of hemodialysis treatment incurred a lower health care cost. Facility-based analysis conducted by DOPPS demonstrated that the characteristics of blood access rather than practice pattern of each facility affected access failure. Therefore, we recommend the creation of an AVF or AVG at least 14–30 days before the initiation of hemodialysis. Bibliography 1. Lorenzo V, et al. Am J Kidney Dis. 2004;43:999–1007. (Level 4)   2. Wasse H, et al. Sem Dial. 2008;21:483–9. (Level 4)   3. Ng LJ, et al. Nephrol Dial Transplant. 2011;26:3659–66. (Level 4)   4. Rayner HC, et al. Kidney Int. 2003;63:323–30. (Level 4)   5. Ravani P, et al. J Am Soc Nephrol. 2004;15:204–9. (Level 4)   6. Wu LC, et al. Kaohsiung J Med Sci. 2009;25:521–9. (Level 4)   7. Saran R, et al. Nephrol Dial Transplant. 2004;19:2334–40. (Level 4)   Chapter 19: Kidney transplantation Is preemptive kidney transplantation recommended to improve mortality? Preemptive kidney transplantation

(PEKT) has been shown to improve mortality and graft survival and to decrease rejection rates. It has also been suggested Megestrol Acetate that PEKT may improve the quality of life by allowing the patient to be free from dialysis and related drawbacks such as a strict diet, fluid control, and hospitalization due to vascular access trouble. These advantages may be even greater for pediatric patients in order to support healthy growth. Medical financial issues also favor PEKT compared to the institution of dialysis. Recent studies have, however, suggested that PEKT may only have a favorable outcome compared with cadaveric kidney transplantation. It is anticipated that further studies will clarify the advantages of PEKT compared with more recent data on kidney survival in non-PEKT patients. Timing of PEKT should be judged carefully since performing PEKT too early, before reaching the eGFR value of 15 ml/min/1.