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 the time 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 arteriovenous access, deemed by the treating healthcare providers * Native vasculature deemed preoperatively to be suitable for surgical creation of either 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 three conditions: 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 of planned study access creation, unless corrected prior to randomization * Planned arteriovenous fistula creation by means other than suture or vascular anastomotic 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 participating centers 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 good candidate for study participation.