OBJECTIVES: Vascular access (VA) is crucial to managing end-stage renal disease (ESRD), facilitating substitution by hemodialysis (HD) and thus enhancing duration and quality of life (QoL). Although patient experience is very relevant, patient-reported outcomes are rarely used in the decision-making process. A qualitative investigation was performed on a pool of Italian HD patients with ESRD to understand their psychosocial experience, including physical function, emotional impact, family and social relationships, ability to work or attend school, sleep patterns, and interactions with HD centers.

METHODS: Analysis of data from patients with ESRD undergoing regular HD for at least six months (HD ≥6 months), with or without previous kidney transplantation, using the grounded theory method, supported by MAXQDA-2022 software focusing specifically on the frequency of identified codes and sub-codes. Patients voluntarily completed an open questionnaire addressing experience with the various types of vascular access (CVC, AVF, AVG).

RESULTS: High variability in VA type: 30.0% (N=30) with AVF only, 26.7% CVC to AVF, 13.3% AVF to CVC, 10.0% graft, 6.7% a simple history of VA (AVF, CVC constant over time); the remaining 13.3% had more complex history (CVC infection, graft closure, thrombosis). CVC was discontinued after the appropriate time in 10%, irrespective of HD months. VA had the greatest impact on social functionality, daily activities/physical functionality, physical symptoms and sleep domains. Patients ≤65 years (60%) suffered in the subdomains of work, family, recreation/travel. QoL was affected due to impairment of daily activities, attention, fear, anxiety, worry and having to accept the clinical situation. AVF had a greater impact than CVC and AVG in almost all domains. Patients preferred fistulas, regardless of HD years and geographical location.

CONCLUSIONS: Patients should be involved in VA selection: awareness of alternatives and their impact on QoL should be discussed by healthcare practitioners in respect of the patient's life plan and preferences. (24MD2015-EN01)