OBJECTIVES: The vascular access type has implications on successful hemodialysis. This real-world analysis investigated the vascular access dialysis types: central venous catheter (CVC), arteriovenous fistula (AVF) and arteriovenous graft (AVG) in an Italian clinical practice setting.

METHODS: A retrospective analysis was conducted on administrative databases of a sample of healthcare entities (geographically distributed across Italy), covering almost 10% of Italian population. Between 01/2009-08/2022, patients with ≥1 record of hemodialysis (procedure code 39.95 and/or hospitalization code V56.0) were included. The first hemodialysis record was the index-date; the vascular access type (CVC, AVF, AVG) was evaluated before and after the index-date.

RESULTS: 3,451 hemodialysis patients were included; 61.7% males, mean age of 68.7 years. Among them, 48.6% had a single vascular access implantation: 33.1% had CVC only, 14.7% AVF only and 0.8% AVG only. Considering patients with ≥1 vascular access type, 24.9% were implanted with both CVC and AVF [14.5% (N = 502) started with CVC followed by AVF (after a mean of 218 days), 10.4% (N = 360) started with AVF followed by CVC (after a mean of 664 days)] and 0.8% (N = 26) had CVC-AVF-AVG pathway (after a mean of 169 and 439 days, respectively). Among AVG users (N=191, 5.5%), 47% (N = 90) started with AVG and 53% (N = 101) had AVG after an AVF or CVC. Among patients who switched vascular access, the mean duration (days) on the first vascular access was 533 ± 768 for CVC, 913±936 for AVF and 688 ± 846 for AVG.

CONCLUSIONS: This real-world analysis shows vascular access types used in hemodialysis patients in Italy. Almost 50% of patients had a single vascular access implantation, almost 25% alternated CVC/AVF and 5.5% had AVG. These results could be informative on the management of hemodialysis patients in clinical practice in Italy.