Satisfaction and complications of vascular access-related interventions among hemodialysis patients: a cross-sectional study in Palestinian practice

Background: Hemodialysis continues to be a life-supportive treatment for patients with end-stage renal disease. It is dependent on access to suitable vascular access. The arteriovenous fistulas (AVFs) remain the most favorable type of access due to their lesser tendency toward infection and thrombosis. The other commonly used accesses include arteriovenous grafts and central venous catheters (CVCs). Complications range from thrombosis and infection to frequent disruption and emotional disturbances, often significantly affecting the quality of life. (Figure1) JOURNAL/ijsgh/04.03/02054256-202601000-00010/figure1/v/2026-01-21T140556Z/r/image-jpeg Methods: In this cross-sectional study, a total of 350 hemodialysis patients were recruited in two major health facilities across the State of Palestine. Types of vascular accesses used, the development of complications, and levels of patient satisfaction are assessed using the Vascular Access Questionnaire. Analyses of association by ANOVA and related techniques were made for vascular access types, interventions, and their results. Results: AVFs were the most commonly used access (75%), associated with better outcomes and fewer complications. CVCs, utilized by 20% of patients, had the highest rates of infection and routine disruption. Interventions like angioplasty were associated with improved satisfaction ( P = 0.03) but also increased physical complications ( P = 0.062) and routine disruption ( P = 0.001). Catheter-related procedures, such as exchanges over a guidewire, showed the highest rates of infection ( P < 0.001) and routine disruption ( P < 0.001). Conclusion: AVFs remain the preferred vascular access due to their superior safety profile and patient satisfaction. However, all types of vascular accesses are associated with significant physical and emotional burdens. Integrated, patient-centered approaches that balance clinical effectiveness with quality of life are required.