Do you recommend placement of a backup AV fistula in an advanced CKD patient who is planning to do peritoneal dialysis?

This is a controversial point for which I don't believe there to be great data. An old study in the British literature- I can't get my hands on it right now- purportedly demonstrated that only 7% of such fistulae were ever used/ useable. With improved fistula technique and survival this number is undoubtedly higher today. That said, my answer is "no"; I do not routinely place a backup AVF in patients planning to start PD. However, when a PD patient demonstrates that s/he may need to switch to HD...

I asked the same question on ASN open forum and Dr. Joanne Bargman compared this to walking down the aisle with your loved one on one side and a divorce lawyer on the other side.

I don't see any reason to put an AVF as a backup on a patient who is just starting PD. AVF surgery is not without risks and complications of AVF long term are well known.

Yes, absolutely. Can’t tell you how many patients who have avoided the dreaded CVC and/or a hospitalization by doing this.

I would consider establishing a vascular access in PD patient at the outset. Many PD patients for several reasons may need a backup HD support even for a few weeks of rest from PD. If there is a mature vascular access available, it would avoid placement of a temporary or tunneled venous access.