Types and Duration of Vascular Access for Hemodialysis in the Kurdistan Region of Iraq: A Multi-Center Study

Background and Objectives: The increasing prevalence of chronic kidney disease highlights the need for adequate vascular access in hemodialysis. The study aims to investigate types and durations of vascular access in hemodialysis. Method: A multi-center observational study was conducted at four hemodialysis centers in the Kurdistan Region of Iraq (Qirqa, Shar, Rania, and Halabja) from November 2021 to April 2022, involving 166 patients. Patients were interviewed about their vascular access types: arteriovenous fistula, non-tunneled central venous catheter, and tunneled central venous catheter. Results: Of the participants, 82.5% used arteriovenous fistulae with a median duration of 2.5 years, varying by center (Rania 95.3%, Halabja 38.5%). Non-tunneled central venous catheters were used by 7.8%, predominantly in Halabja (30.8%), with a median duration of 0.8 years. Tunneled central venous catheters were used by 9.6% for a median of one year. Among arteriovenous fistula users, 68.1% previously relied on non-tunneled central venous catheters for an average of 5.2 months. Meanwhile, 7.8% of tunneled central venous catheter users had prior non-tunneled central venous catheters used for 5.6 months, exceeding recommended temporary limits. All results were statistically significant. Conclusion: arteriovenous fistulae were preferred for fewer complications and better outcomes, yet many patients still depend on central venous catheters beyond recommended limits. Early arteriovenous fistula creation and education on central venous catheter risks are crucial for enhancing hemodialysis care and patient outcomes in the Kurdistan Region.