Arteriovenous Fistulas Improve Quality of Life Over Central Venous Catheters in Hemodialysis Patients, suggests Review

While end-stage kidney disease (ESKD) heavily burdens global health and previous reviews predominantly evaluated clinical outcomes like survival or infection rates, conclusive evidence regarding patient well-being remained ambiguous due to widespread methodological heterogeneity. Bridging this critical clinical gap, Noel Matthew Imaniku Sihombing and colleagues from the Universitas Sumatera Utara, Indonesia, aimed to systematically synthesize current evidence comparing the impacts of AVF and CVC on HRQoL to guide patient-centered vascular access decisions.

Therefore, in a systematic review of 15 global studies involving nearly 10,000 adult hemodialysis patients, researchers compared how arteriovenous fistulas and central venous catheters impact patient quality of life. To ensure highly reliable results, the study exclusively analyzed data gathered from trusted, validated quality-of-life questionnaires.

Key Clinical Findings of the Study Review:

• Overall Superiority: AVF demonstrated significant benefits over CVC across disease-specific, physical, and mental domains in 12 out of the 15 analyzed studies.

• Quantitative Edge: Participants utilizing fistulas exhibited notably higher mean scores, outperforming catheter users by +4.32 in kidney disease-specific quality of life, +4.71 in physical components, and +4.57 in mental components.

• Catheter Benefits: Conversely, CVC provided targeted advantages in four studies, particularly regarding reduced bodily pain and better general health perception for older individuals with multiple comorbidities.

• Complication Reduction: AVF access consistently resulted in fewer dialysis-related complications, such as lower hospitalization rates, which significantly improved daily social functioning activities like bathing and sleeping.

• Demographic Modifiers: The HRQoL benefits of AVF were most pronounced in younger populations under 65 years and Asian cohorts, whereas older or highly comorbid European populations showed more neutral outcomes.

The results suggest that establishing an AVF generally secures a substantially better HRQoL for hemodialysis patients than relying on a CVC, evidenced by consistent superiority across 80% of the reviewed studies.

Thus, the review concludes that while AVF should confidently remain the preferred initial choice to maximize overall patient well-being and clinical stability, clinicians might practically consider CVC as a viable alternative access strategy for elderly patients burdened with severe comorbidities, frailty, or limited life expectancy, especially in scenarios where immediate symptom relief and avoiding surgical interventions outweigh the long-term benefits of a fistula.

The reliance on predominantly cross-sectional designs limits the ability to establish definitive causal relationships between access types and HRQoL changes, gently highlighting the exciting need for future investigations to adopt prospective methodologies and standardized clinical metrics to further enrich our understanding of patient outcomes.

Reference

Sihombing NMI, Nasution BR, Siahaan SRU. Arteriovenous Fistula Versus Central Venous Catheter: A Systematic Review of Impact on Quality of Life in Hemodialysis Patients. IJN. 2026 Jun 25.