Nutritional support for vascular access

Haemodialysis vascular access remains a critical lifeline for patients with end-stage renal disease. However, vascular access failure can occur driven by inflammation, thrombosis and vascular dysfunction. This article explores the emerging and sometimes conflicting evidence on the role of key nutritional factors in supporting vascular health, improving access outcomes and shaping future clinical practice. Background: Nutritional support of normal vascular function is an important factor in facilitating vascular access, by reducing the risk of vascular thrombosis, oxidative stress, inflammation, stenosis, calcification and impaired wound healing, all of which can contribute to arteriovenous fistula and arteriovenous graft failure. Aim: To outline the role of deficiency and supplementation of key nutrients (including B vitamins, vitamins C, D, E and K2, omega 3 polyunsaturated fatty acids and zinc) to support vascular access, based on their anti-thrombotic, antioxidant, anti-inflammatory, anti-stenotic, anti-calcification and wound healing supporting characteristics. Conclusions: Evidence highlights the important role of nutritional factors in influencing vascular access outcomes in haemodialysis patients. Future large-scale, well-designed longitudinal studies are needed to clarify which patients are most likely to benefit, at what stage of disease and with which specific interventions. A more individualised, targeted approach to nutritional support may ultimately improve vascular access outcomes in this high-risk population.