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Results between studies were contradictory with some reporting improvements in incident AVF/G use and some no significant difference. Quality was generally low. It is not possible to reach firm conclusions nor make strategic recommendations. A comprehensive package of care which educates and identifies patients approaching dialysis in a timely manner may improve incident AVF/G use. An unbiased, robust comparison of different strategies for timing AVF/G referral is required. It is not possible to reach firm conclusions nor make strategic