Types of Vascular Access and Associated Clinical Outcomes in Dialysis Patients.

Background Vascular access in patients with end-stage renal disease (ESRD) plays a crucial role in determining both the quality of life and survival rates, as it directly affects dialysis effectiveness. It connects the patient to the dialysis machine and significantly impacts the dialysis dose by influencing blood flow efficiency. Despite advancements in technology, improved care, and collaborative efforts by healthcare providers and patients, complications related to vascular access continue to be a major cause of hospitalizations and mortality among patients with ESRD. Our study aims to evaluate how vascular access impacts the dialysis dose and clinical outcomes, with the ultimate target of enhancing patients' quality of life while minimizing costs to the healthcare system. We seek to identify new strategies to reduce complications associated with vascular access, which contribute to inadequate dialysis and higher mortality rates, and to encourage the integration of these strategies into routine clinical practice. Methodology This retrospective study was conducted at the Clinic of Nephrology and Dialysis at the University Hospital "St. Marina" in Varna, Bulgaria, over five years, from January 2017 to December 2021. During this period, the medical records and routine laboratory tests of 87 patients who met the study criteria were reviewed. Patients were categorized into two groups based on the type of permanent vascular access: Group 1 included 45 patients with an arteriovenous fistula (AVF), and Group 2 included 42 patients with a permanent tunneled vascular catheter (PC). During the study period, the specified indicators, along with recorded mortality and hospitalization rates, were analyzed in relation to the type of vascular access. Results Our analysis demonstrated the significant superiority of AVF in several key areas. Specifically, patients with AVF showed significantly higher dialysis adequacy, as measured by the single-pool Kt/V index (spKt/V) and urea reduction ratio (URR), along with higher serum hemoglobin levels and lower erythropoietin requirements (< 0.0001). The results of our study showed that using PC as vascular access is associated with a significantly higher risk of death, four times greater than in patients with AVF (< 0.0001). The significantly higher incidence of complications in the PC is well-researched and is directly linked to an increased rate of hospitalizations and mortality in this group. These outcomes are primarily due to access-related events, but also reflect the broader impact of compromised dialysis adequacy. Inadequate dialysis, in turn, worsens clinical outcomes, potentiating issues such as malnutrition, chronic inflammation, and immune dysfunction. These factors collectively contribute to the poor prognosis observed in patients with PC, reinforcing the importance of optimal vascular access in improving patient survival and quality of life. Conclusions In conclusion, although indwelling tunneled catheters may be necessary in certain situations, our findings confirm the superior outcomes associated with the use of AVF in terms of dialysis adequacy, survival, anemia control, and overall quality of life, data supported by two large multicenter trials on this topic. AVF placement must be prioritized whenever possible to reduce complications and improve the long-term prognosis of patients with ESRD.