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Arteriovenous shunt cannulation in hemodialysis patients: A prospective cohort study of outcomes and complications in a resource-limited healthcare system

Year: 2025

Type: article

Abstract: Objectives: The primary objective of this study was to assess the outcomes and complication rates associated with different arteriovenous shunt cannulation methods among patients with end-stage chronic kidney disease. Methods: The study was carried out at two major hemodialysis centers in a resource-limited healthcare system. A total of 309 patients were included. Vascular access was achieved using the area puncture technique in 171 patients (55.3%) and the rope-ladder technique in 138 patients (44.7%). Results: Of the patients, 62 (20.1%) suffered vascular access complications (0.63 events/1000 access days). Hematoma was the most common complication, occurring in 43 patients. Hematoma was significantly associated with female sex ( p = 0.024), shorter hemodialysis vintage ( p = 0.026), and longer duration of hemodialysis sessions ( p = 0.048). High venous access pressure was significantly associated with the rope-ladder technique ( p = 0.022), jugular implanted shunts ( p < 0.001), and with longer duration of hemodialysis sessions ( p = 0.002). Bleeding was associated with a shorter hemodialysis vintage ( p = 0.047). Infection was significantly associated with the area puncture technique ( p = 0.043) and with cannulation during the noon dialysis shift ( p = 0.007). Moreover, thrombosis was significantly associated with female sex ( p = 0.014), residing in rural areas ( p = 0.018), and absence of comorbidities ( p = 0.008). Conclusion: Our findings underscore the critical need to implement evidence-based protocols, enhance staff training, and address systemic obstacles in vascular access management.

Source: SAGE Open Medicine

DOI: 10.1177/20503121251407165