# Patient Perceptions of Vascular Access and Quality of Life in Maintenance Hemodialysis: A Multicenter Study on Patient-Centered Outcomes

## TL;DR

This study found that the type of vascular access used in hemodialysis affects patients' quality of life, with fistulas linked to better outcomes than catheters.

## Contribution

The study provides new evidence linking vascular access satisfaction and type to specific quality-of-life domains in hemodialysis patients.

## Key findings

- Arteriovenous fistula use is associated with better SF-36 quality of life scores compared to permanent catheters.
- Patient satisfaction with vascular access and factors like age and BMI independently affect physical and psychosocial quality of life.
- Lower vascular access satisfaction correlates with worse HRQoL scores across multiple domains.

## Abstract

What are the main findings?
Vascular access type was associated with meaningful differences in patient-reported quality of life among maintenance hemodialysis patients, with arteriovenous fistula use linked to better scores in several SF-36 domains than permanent catheter use.Patient satisfaction with vascular access and selected sociodemographic/clinical factors (e.g., age, education, marital status, BMI, and dialysis duration) independently contributed to variability across physical and psychosocial quality-of-life dimensions.

Vascular access type was associated with meaningful differences in patient-reported quality of life among maintenance hemodialysis patients, with arteriovenous fistula use linked to better scores in several SF-36 domains than permanent catheter use.

Patient satisfaction with vascular access and selected sociodemographic/clinical factors (e.g., age, education, marital status, BMI, and dialysis duration) independently contributed to variability across physical and psychosocial quality-of-life dimensions.

What are the implications of the main findings?
Vascular access planning should integrate clinical suitability with patient-centered outcomes, prioritizing fistula creation when feasible and monitoring access satisfaction as part of routine follow-up.Targeted supportive interventions may be warranted for patients at higher risk of poorer quality of life (e.g., those using catheters or reporting low access satisfaction), to improve symptom burden, engagement, and overall well-being.

Vascular access planning should integrate clinical suitability with patient-centered outcomes, prioritizing fistula creation when feasible and monitoring access satisfaction as part of routine follow-up.

Targeted supportive interventions may be warranted for patients at higher risk of poorer quality of life (e.g., those using catheters or reporting low access satisfaction), to improve symptom burden, engagement, and overall well-being.

Background: Vascular access is a core component of hemodialysis and may influence both clinical outcomes and patient-reported quality of life. This study examined the association between vascular access type and quality of life among patients receiving maintenance hemodialysis in multiple nephrology centers. Methods: We conducted a multicenter, cross-sectional observational study of 152 adults with end-stage kidney disease undergoing hemodialysis in public and private dialysis units in the Attica region, Greece (January–May 2022). Data were collected using a demographic/clinical questionnaire, the 36-Item Short Form Health Survey (SF-36), the Dialysis Patient Satisfaction Questionnaire (SDIALOR), and the Missoula VITAS Quality of Life Index (MVQOLI). Multivariable linear regression models were fitted for SF-36 and MVQOLI domain scores. Results: Most participants reported being very (40.8%) or quite (53.3%) satisfied with their current vascular access, and 69.5% considered an arteriovenous fistula (AVF) the most appropriate option. SF-36 scores were generally lower than those reported for the general population, except for the mental health domain. Compared with AVF, permanent catheter use was associated with lower SF-36 physical functioning scores, and graft use was associated with lower vitality scores. Lower vascular access satisfaction was consistently associated with lower HRQoL: compared with being “very” satisfied, being “quite” satisfied was associated with lower general health, vitality, social functioning, mental health, and lower PCS/MCS scores, while being “a little/not at all” satisfied was associated with lower general health and worse bodily pain scores. On MVQOLI, living alone and lower access satisfaction were associated with lower interpersonal relationships, transcendence/spirituality, and overall quality-of-life scores, while obesity was associated with lower function scores. Conclusions: Vascular access type, particularly AVF versus catheter, is associated with meaningful differences in quality of life among hemodialysis patients. Patient satisfaction with access and sociodemographic characteristics should be considered in patient-centered access planning and follow-up.