Who Develops Recurrent Hemodialysis Vascular Access Failure? Clinical, Biochemical, and Access-Related Determinants in a Multicenter Cohort Recurrent Hemodialysis Vascular Access Failure

Abstract

Background: Recurrent vascular access failure imposes repeated procedures and threatens continuity of hemodialysis, yet recurrence phenotypes are less well characterized than single access failure.

Methods: We performed a retrospective secondary cohort analysis of 381 adults receiving maintenance hemodialysis at two centers in Al-Ahsa, Saudi Arabia. Recurrent failure/immaturation was defined a priori as at least two documented access failure or immaturation episodes. Modified Poisson regression with robust variance estimated adjusted risk ratios (aRRs). Biochemical associations were examined in prespecified center-, age-, and sex-adjusted models with false-discovery-rate correction.

Results: Recurrent failure/immaturation occurred in 38 patients (10.0%; 95% CI 7.4%-13.4%). Among 102 patients with any failure history, 37.3% had recurrence. Thrombosis was recorded in 63.2% of recurrent cases and stenosis in 47.4%. Treatment center was associated with recurrence in the primary model (aRR 2.62, 95% CI 1.19-5.79; p=0.017), but this association weakened in sensitivity analyses. No biochemical marker remained associated after multiplicity correction.

Conclusions: Recurrent access failure affected one in ten patients and was dominated by thrombotic and stenotic mechanisms. Recurrence should trigger structured access review and documentation, while center-level variation requires prospective validation before being interpreted as a quality signal.