Vascular Access Patency and Complications in Chronic Hemodialysis Patients — An Observational Study

Abstract

Background: Functional vascular access is the cornerstone of maintenance hemodialysis. The arteriovenous fistula is recommended as the preferred access, yet catheter dependence remains high in developing countries with limited pre-dialysis nephrology care. Methods: A prospective observational study evaluated 150 chronic hemodialysis patients at a tertiary nephrology unit in India from Feb 2022 to Jan 2023. Access type, creation-to-maturation time, primary and secondary patency rates, and access-related complications were documented. Patients were followed for a minimum of 12 months. Results: AVF was the access type in 94 patients (62.7%), tunnelled catheter in 36 (24.0%), and AV graft in 20 (13.3%). Among AVF patients, the radiocephalic fistula was most common (56.4%) followed by brachiocephalic (34.0%). Primary AVF patency at 12 months was 78.7% and secondary patency was 88.3%. AVF maturation failure occurred in 14.9%. Catheter-related bloodstream infection rate was 2.4 per 1000 catheter-days. AVF thrombosis occurred in 8.5%, stenosis in 12.8%, steal syndrome in 3.2%, and aneurysm formation in 6.4%. Independent predictors of AVF failure were diabetes (OR 2.86, p equals 0.006), peripheral vascular disease (OR 3.42, p equals 0.002), and female sex (OR 2.14, p equals 0.028). Conclusion: AVF demonstrated superior patency and fewer complications compared to catheters. Timely referral for AVF creation and pre-dialysis nephrology care are essential to reduce catheter dependence.