Initial results from a Dutch randomized trial, presented at a U.K. vascular access meeting, add to a growing push for patient-specific access choices and better catheter technology.
Background
For years, U.S. dialysis policy pushed hard for arteriovenous fistulas, which are surgical connections between an artery and a vein. CMS named Fistula First a Breakthrough Initiative in 2004, with a goal of fistulas for 66% of patients [5]. CMS's own FAQ stated plainly that catheters "are not ideal for permanent access" [5]. U.S. fistula use rose from 32% in 2003 to nearly 60% by 2011 [6].
The 2019 update to the KDOQI vascular access guideline marked a shift. It explicitly moves "away from the prior Fistula First approach" toward a patient-focused "ESKD Life-Plan" that weighs each patient's circumstances and preferences [4]. In vascular access, slogans can take longer to mature than fistulas.
What Was Presented
At the Vascular Access Society of Britain and Ireland (VASBI) annual meeting in Liverpool on September 24–25, 2026, Maarten Snoeijs of Maastricht University shared initial results from the OASIS randomized controlled trial [1]. Interventional News reported on the session on October 26 [1].
OASIS randomized older hemodialysis patients with limited life expectancy to a fistula, a prosthetic arteriovenous graft or a central venous catheter as their first access [1][2]. In total, 165 patients were randomized [1]. Median survival across the full cohort was 2.8 years [1].
On a patient-reported questionnaire, physical symptoms such as pain, bleeding, swelling and bruising were significantly better in the catheter group (p<0.001) [1]. Access-related pain was reported by 7% of catheter patients, compared with 31% for fistulas and 38% for grafts [1]. Social and emotional scores and overall complication rates were similar across groups [1]. "What this study shows is that catheters are very well tolerated," said Nicholas Inston of Queen Elizabeth Hospital Birmingham [1].
Study Design and Limitations
According to the published protocol, OASIS is a multicenter Dutch superiority trial funded by ZonMw [2]. It enrolled patients aged 70 or older who were starting or had recently started hemodialysis, and it excluded those expected to live less than six months [2][3]. The planned sample size was 195 [2], so the 165 randomized fell short of that target.
The trial's primary endpoint, the number of access-related interventions per year of dialysis, has not been reported yet [1][2]. The symptom and pain findings are secondary outcomes [2]. These are initial conference data, not peer-reviewed results.
Catheters also carry well-documented risks. In 2020 national data, CDC researchers found that dialysis patients with a central venous catheter had about six times the risk of a Staphylococcus aureus bloodstream infection compared with those using a fistula [7].
The Fibrin Sheath Problem
The meeting also focused on fibrin sheath, a protein film that coats a catheter and can block flow [9]. According to Inston, a fibrin sheath forms on 80% to 100% of catheters within the first week [1]. He serves as a spokesperson for the new Fight Fibrin Sheath campaign, a clinician-led group whose supporters include industry partners [1][10].
Inston highlighted a global Dialysis Catheter Collaborative survey of 111 clinicians in 37 countries. In that survey, 52% named fibrin sheath and thrombosis as the main limit on catheter lifespan, ahead of infection (29%) and malposition (15%) [1]. Only 38% believed current technology can prevent fibrin sheath [1].
This is where interventional radiology comes in. KDOQI recommends image-guided catheter insertion [4], and a Cochrane review found that physical disruption of a fibrin sheath with interventional radiology techniques appeared about as effective as clot-dissolving drugs [8]. In one published series, catheters that stayed dysfunctional were referred to interventional radiology for salvage [11].
What Comes Next
The OASIS investigators have yet to present the primary endpoint. Until they do, the trial cannot say which access type leads to fewer procedures. For now, the early data support an idea already in the guidelines: for some older patients, the right access may not be a fistula.
This article is for informational purposes only. Readers should consult their clinician about any health concerns.
References
Bell J. "From fistula-first to fighting fibrin sheath: VASBI delegates discuss re-emergence of catheters in vascular access." Interventional News. October 26, 2026. https://interventionalnews.com/vasbi-delegates-discuss-re-emergence-of-catheters-in-vascular-access/
Heggen BDC, Ramspek CL, van der Bogt KEA, et al.; OASIS study group. "Optimising Access Surgery in Senior Haemodialysis Patients (OASIS): study protocol for a multicentre randomised controlled trial." BMJ Open. 2022;12(2):e053108. doi:10.1136/bmjopen-2021-053108. https://bmjopen.bmj.com/content/12/2/e053108
Netherlands Trial Register / Onderzoek met mensen. OASIS trial registration NL7933. https://www.onderzoekmetmensen.nl/en/node/28751/pdf
Lok CE, Huber TS, Lee T, et al.; KDOQI Vascular Access Guideline Work Group. "KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update." American Journal of Kidney Diseases. 2020;75(4 Suppl 2):S1-S164. doi:10.1053/j.ajkd.2019.12.001. https://www.kidney.org/sites/default/files/2026-07/2019-kdoqi-guideline-vascular-access.pdf
Centers for Medicare & Medicaid Services. "Fistula First: Frequently Asked Questions." November 2004. https://cms.gov/medicare/end-stage-renal-disease/esrdqualityimproveinit/downloads/fffaqs.pdf
Vassalotti JA, et al. "Fistula First Breakthrough Initiative: Targeting Catheter Last in Fistula First." Seminars in Dialysis. 2012;25(3):303-310. doi:10.1111/j.1525-139X.2012.01069.x. https://researchconnect.buffalo.edu/en/publications/fistula-first-breakthrough-initiative-targeting-catheter-last-in-/
Rha B, See I, Dunham L, et al. "Vital Signs: Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections — United States, 2017–2020." MMWR. 2023;72(6):153-159. doi:10.15585/mmwr.mm7206e1. https://www.cdc.gov/mmwr/volumes/72/wr/mm7206e1.htm
Kennard AL, Walters GD, Jiang SH, Talaulikar GS. "Interventions for treating central venous haemodialysis catheter malfunction." Cochrane Database of Systematic Reviews. 2017;(10):CD011953. doi:10.1002/14651858.CD011953.pub2. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011953.pub2
Radiopaedia. "Fibrin sheath." Revised January 12, 2024. https://radiopaedia.org/articles/fibrin-sheath
Fight Fibrin Sheath. "The FFS (Fight Fibrin Sheath) campaign launches to improve patient lives by tackling dialysis catheters' most common dysfunction." News-Medical. September 22, 2026. https://www.news-medical.net/news/20260922/The-FFS-(Fight-Fibrin-Sheath)-campaign-launches-to-improve-patient-lives-by-tackling-dialysis-catheters-most-common-dysfunction.aspx
Ahmed R, Chapman SA, Tantrige P, et al. "TuLIP (Tunnelled Line Intraluminal Plasty)." CardioVascular and Interventional Radiology. 2019;42:770-774. doi:10.1007/s00270-019-02189-7. https://link.springer.com/article/10.1007/s00270-019-02189-7
