Vascular access creation and maintenance is essential for providing hemodialysis to patients with End Stage Renal Disease (ESRD). Complications from vascular access are common and account for 16 to 25 % of hospital admissions for ESRD patients. The estimated financial costs of vascular access related morbidity is over $ 1 Billion annually. Recent studies suggest that specific types of vascular access may be associated with better access survival and function. It remains unknown, however, whether these differences in access survival and function lead to better clinical and economic outcomes. Accordingly, the purpose of this study is: 1) to compare mortality rates and hospitalization rates in hemodialysis patients according to various vascular access strategies at initiation of hemodialysis 2) to estimate cost of care per patient year for hemodialysis patients based on vascular access types. If important clinical and economic outcomes are associated with specific vascular access types, then an improved choice of access at hemodialysis initiation could lead to substantial reductions in mortality and hospitalization rates, and cost of care for hemodialysis patients:
