To the Editor: The study by Dr Dember and colleagues1 is notable for the highest rate of failure to attain suitability for dialysis (clopidogrel, 61.8%, vs placebo, 59.5%; P = .40) that we are aware of in the published literature. The challenge of vascular access for hemodialysis patients is that success requires knowledgeable and skillful input from several disciplines, including nephrology, radiology, and vascular surgery. Although the investigators took great care in the assessment of various elements of the trial, the possible effect of surgical expertise on the outcome of fistulas was perhaps not optimally assessed.
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