n the era of “Fistula First,” the impact of CVC use on subsequent AVF outcomes must be noted. Pisoni et al. used the DOPPS database to compare patient and access survival between incident and prevalent HD patients using AVFs and arteriovenous grafts (AVGs) (34). The authors noted that the pattern of AVF vs. graft survival is more complex if patients use a catheter for their first HD treatment vis-à-vis the survival of a subsequently used AVF or AVG. In this situation, no significant difference was observed in AVF vs. graft survival in the United States during the first 240 days