Vascular access-related complications in chronic kidney disease patients undergoing hemodialysis: experience from a tertiary care center

Abstract Background: Most patients with chronic kidney disease (CKD) eventually need renal replacement therapy, including hemodialysis (HD), peritoneal dialysis, or kidney transplantation. Among these options, HD is the most commonly used modality. Vascular access (VA)-related complications pose a major challenge in patients undergoing chronic HD and are a leading cause of morbidity, frequent hospitalizations, and increased healthcare costs, placing a significant burden on healthcare systems. Objective: This study aimed to evaluate VA-related complications among patients with CKD undergoing HD. Materials and Methods: This hospital-based cross-sectional study was conducted over 10 months, from September 2023 to June 2024, involving adult patients with CKD on HD admitted with acute or chronic VA-related complications. Although arteriovenous (AV) access, either native fistula or synthetic graft, is preferred over venous catheters due to higher blood flow rates, various access-related complications still occur. Patients with any duration of VA were included. Data on the type of VA and associated complications were collected and analyzed. Results: A total of 78 patients were included in the study, with a mean age of 53.69 ± 12.21 years. Tunneled catheters were used by 28 patients (35.9%), AV fistulas by 27 patients (34.6%), femoral catheters by 19 patients (24.4%), and internal jugular vein (IJV) catheters by 4 patients (5.1%). In 64 patients (82.1%), the duration of VA was less than 6 months. Complications related to AV fistulas included access failure (55.56%), thrombosis (25.93%), aneurysm formation (11.11%), and bleeding or hematoma (7.41%). Among patients with tunneled catheters, catheter-related bloodstream infection was the most common complication (60.71%), followed by accidental catheter dislodgement (25%) and hemopneumothorax (7.14%). In patients with femoral and IJV catheters, deep vein thrombosis was observed in 13 cases (56.5%), while hematoma formation occurred in 10 cases (43.4%). Conclusion: This study highlights a significant burden of VA-related complications in CKD patients on HD. AV fistulas and tunneled catheters were the most common access types and were associated with notable complications, including fistula failure, thrombosis, aneurysm formation, and catheter-related bloodstream infections. These results underscore the need for careful selection of VA, early monitoring, and improved management strategies to reduce morbidity and improve patient outcomes.