Association between vascular access types and mortality in hemodialysis patients: A systematic review and meta-analysis

Abstract Objective To compare the mortality of different vascular access types in hemodialysis patients by using systematic review and meta-analysis of observational research. Methods Through a systematic literature search in PubMed and Embase databases, the English publications that directly compared the mortality of vascular access types in hemodialysis patients from 2000 to 2022 were determined. The outcomes of this study are based on the mortality hazard ratio (HR) of vascular access types. Moreover, using a random-effects model to calculate the pooled HR [95% CI] and I2 to show the heterogeneity among the included studies. Results Of the 4,802 studies screened, 19 studies involving 575,109 patients met the inclusion criteria and were included in the analysis. Meta-analyses revealed the significant difference for the adjusted HR of death among various vascular access types. The results of meta-analysis showed that the mortality of using central venous catheter (CVC) for hemodialysis patients was higher than using arteriovenous fistula (AVF) (pooled HR = 1.85; 95% CI, 1.55–2.22). Further, the mortality of patients with arteriovenous graft (AVG) was higher than patients with AVF (pooled HR = 1.24; 95% CI, 1.12–1.36), while the mortality have no statistically significant difference between CVC use and AVG use was found (pooled HR = 1.41; 95% CI, 1.31–1.52; P > 0.05). Conclusions The mortality of patients with CVC was higher than those with AVF for hemodialysis, while patients using AVG had higher mortality than those using AVF.