From Catheter Initiation to Arteriovenous Access: Transition Patterns and Factors Associated with Definitive Access Establishment among Adults Receiving Maintenance Hemodialysis in Saudi Arabia Catheter-to-Arteriovenous Access Transition

Abstract

Background: Persistent central venous catheter dependence after hemodialysis initiation is clinically important, but transition to definitive arteriovenous access is poorly characterized in Saudi Arabia.

Methods: We performed a retrospective multicenter secondary cohort analysis of adults receiving maintenance hemodialysis at two centers in Al-Ahsa. Patients whose first documented access was a permanent catheter were followed through recorded access history. The primary outcome was subsequent arteriovenous fistula or graft establishment. Modified Poisson regression with robust variance estimated adjusted risk ratios.

Results: Among 264 catheter-initiating patients, 144 (54.5%; 95% CI 48.5-60.4%) subsequently established arteriovenous access; 136 received fistulas and eight grafts. Median time to creation was 4.3 months (IQR 1.8-12.9). Cardiovascular comorbidity was independently associated with lower transition probability (aRR 0.60, 95% CI 0.42-0.84; p=0.003). Recent ESKD diagnosis, refusal, prior access failure, low ejection fraction, and surgical unsuitability were common barriers.

Conclusions: Nearly half of catheter-initiating patients lacked documented definitive arteriovenous access. Structured, individualized transition pathways may reduce avoidable catheter dependence.