Vascular Access Type and Survival Outcomes in Hemodialysis Patients: A Seven-Year Cohort Study

Background and Objectives: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to their impact on patient outcomes, including survival, infection rates, and overall quality of life. Despite strong recommendations favoring AVF, gaps in AVF utilization remain, influenced by clinical, demographic, and systemic factors. This study is the first to analyze survival outcomes associated with different dialysis vascular access types, adjusting for key clinical, demographic variables, and other comorbidities over extended periods. Materials and Methods: This ambispective cohort study followed 428 hemodialysis patients over seven years. Patients were categorized based on their access type: AVF (n = 189), tunneled central venous catheter (CVC) (n = 178), and non-tunneled CVC (n = 61). Kaplan-Meier survival analysis was used to estimate survival curves, and Cox proportional hazards regression adjusted for potential confounders, including age, diabetes, and hypertension. Results: The 2-year survival rates were as follows: AVF 94.1%, tunneled CVC 70.0%, and non-tunneled CVC 36.6%. The 7-year survival rates were as follows: AVF 65.5%, tunneled CVC 26.4%, and non-tunneled CVC 11.0%. Compared to AVF, tunneled CVC use was associated with a 2.8-fold increased risk of mortality (adjusted hazard ratio [AdHR] 2.8, 95% CI 2.0-4.1), while non-tunneled CVC increased the risk 5-fold (AdHR 5.0, 95% CI 3.3-7.6). Notably, older adults, women, and diabetic patients were disproportionately represented in the groups with tunneled and non-tunneled catheters. Conclusions: Adjusted survival analyses highlight the significantly lower survival rates associated with CVC use compared to AVF. Non-tunneled catheters are generally not used for prolonged periods, and this cohort provides evidence of their prognosis for long-term use. These findings reinforce the need to prioritize AVF placement whenever feasible, reinforcing health education on this topic, to improve long-term outcomes for hemodialysis patients.