The current status analysis of hemodialysis vascular access in Sichuan province: An epidemiological cross-sectional survey from southwest China

Objective: To investigate the current status of vascular access in hemodialysis patients and the surgical capabilities of hospitals at all levels in Sichuan Province. Methods: A cross-sectional survey using a questionnaire method was conducted, involving 228 hospitals and 30,067 hemodialysis patients. The current status of hemodialysis vascular access and hospital surgical capabilities were statistically analyzed, and differences in surgical capabilities across hospital levels were compared. Results: The primary first-time vascular access in Sichuan Province was non-cuffed catheters (NCC, 57.42%), with the femoral vein (68.04%) being the main site for initial NCC placement. Notably, 69.3% of patients had indwelling times exceeding 1 month, and 15.79% exceeded 2 months, this phenomenon particularly prominent in prefectural and county-level hospitals (79.73% and 72.86%, respectively), which was significantly influenced by physicians’ surgical capabilities (aOR = 10.23, 95% CI 1.42–73.43, p = 0.021). For long-term hemodialysis access, autogenous arteriovenous fistulas (AVF) were the most common (85.36%), followed by tunnel-cuffed catheters (TCC, 12.59%), with arteriovenous grafts (AVG) accounting for only 1.42%. Vascular access surgeries in Sichuan Province were predominantly performed by nephrologists (78.00% for open surgery, 55.79% for interventional surgery), with stronger open surgical capabilities compared to interventional capabilities (80.18% vs 38.16%). However, only 17.54% of hospitals could perform AVG surgeries. Conclusion: The primary first-time vascular access in Sichuan Province is NCC with prolonged indwelling times, while AVF is the main long-term access. The low proportion of AVG and weak surgical capabilities highlight the need to strengthen access planning and management for end-stage chronic kidney disease patients in hospitals at all levels, particularly improving physicians’ capabilities in AVG and interventional access surgeries.