Impact of vascular access type on dialysis adequacy in hemodialysis patients

Aims: Vascular access type plays an important role in determining dialysis adequacy in patients undergoing maintenance hemodialysis. This study aimed to evaluate the impact of vascular access type on dialysis adequacy and to investigate factors associated with Kt/V values in hemodialysis patients. Methods: This retrospective observational study included 67 patients receiving maintenance hemodialysis in the hemodialysis unit of our hospital. Demographic and clinical data were obtained from electronic medical records. Dialysis adequacy was assessed using the mean Kt/V values calculated from the last three months. Patients were categorized according to vascular access type as arteriovenous fistula (AVF) or central venous catheter. Correlation and multiple linear regression analyses were performed to determine factors affecting dialysis adequacy. Results: The mean age of the patients was 59.07±15.32 years, and 52.2% were female. Among the patients, 47 (70.1%) were using AVF and 20 (29.9%) were undergoing hemodialysis via catheter. The mean Kt/V value was 1.81±0.36. Patients with AVF had significantly higher Kt/V values compared with catheter users (1.95±0.32 vs 1.47±0.18, p=0.001). Female patients also demonstrated higher Kt/V values than male patients (p=0.007); this difference primarily reflects the smaller volume of urea distribution (V) in women rather than superior dialysis delivery. A moderate negative correlation was observed between body mass index and Kt/V (r=-0.504, p<0.01), largely attributable to the larger volume of distribution in patients with greater body mass. Conclusion: Vascular access type significantly affects urea-based dialysis adequacy (Kt/V) in hemodialysis patients. AVF is associated with significantly higher Kt/V values compared with central venous catheter use, though both groups exceeded the KDOQI minimum target of spKt/V ≥1.2.