Mortality Outcomes Associated with Vascular Access Types in Hemodialysis for ESRD: A Systematic Review and Meta-Analysis

Background Hemodialysis is a common renal replacement therapy for patients with end-stage renal disease (ESRD). The common types of vascular access mainly include arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC). However, the association between different access types and all-cause mortality remains controversial. Accordingly, this study aims to systematically assess the effect of different vascular access on mortality among hemodialysis patients with ESRD, thereby providing evidence-based recommendations for optimal vascular access strategies in clinical settings. Methods The systematic searches in PubMed, Embase, Cochrane Library and Web of Science were employed to determine the cohort study or randomized controlled trials comparing the effects of AVF, AVG, or CVC on mortality in patients undergoing hemodialysis. A total of 33 studies were included. Results Meta-analysis results showed the following: 1) All-cause mortality: Compared to AVF, CVCs significantly increased all-cause mortality. AVGs also increased all-cause mortality. 2) Cardiovascular events mortality: Compared to AVF, CVCs and AVGs showed a trend toward higher cardiovascular mortality, but the differences were not statistically significant. 3) In-hospital mortality: Compared to patients without vascular access, AVF was associated with increased in-hospital mortality. 4) Infection-related mortality: Compared to AVF, CVCs significantly increased infection-related mortality. Conclusion Compared with CVCs and AVGs, AVF remains the lowest mortality risk. Early planning and education regarding vascular access are essential to improve long-term outcomes in hemodialysis patients.