Experience of Patients with Vascular Access for Hemodialysis VALE Project-Vascular Access Life Experience
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Abstract
Rationale & objective: For individuals with end-stage kidney disease (ESKD) undergoing hemodialysis (HD), vascular access (VA) is fundamental for extending their lives and enhancing their quality of life (QoL). Placing patients at the heart of dialysis access decisions is crucial, not just addressing immediate access requirements but also looking ahead to their future needs. To facilitate better, it’s essential to understand how various VA methods affect the patient’s overall experience.
Study design: Patient experiences with arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central venous catheters (CVCs) were investigated through individual, semi-structured phone interviews, which utilized a validated questionnaire as a framework.
Setting & participants: Adult ESKD patients undergoing HD for at least six months, including those with prior kidney transplants, were selected. Participants were over 18, ANED (National Association of Dialyzed and Transplanted) members, and volunteers.
Analytical approach: The study’s theoretical framework was built using grounded theory principles. Initial coding was based on themes from a validated questionnaire (Nordyke, et al. 2020), and further codes and subcodes were generated through inductive coding (MAXQDA-2022 software).
Results: The study found significant variation in VA types: 30.0% (N = 30) AVF only, 26.7% CVC to AVF, 13.3% AVF to CVC, 10.0% graft, 6.7% stable VA history, and 13.3% complex histories. Appropriate CVC discontinuation was low (10%). VA type significantly impacted social and daily activities/physical functioning, symptoms, and sleep. Younger patients (≤65%) experienced reduced QoL in work, family, and leisure. Reduced QoL stemmed from impaired daily activities, attention deficits, fear, anxiety, and worry. AVF had a greater impact than CVC and AVG in almost all domains. Patients preferred fistulas, regardless of HD years and geographical location.
Limitations: The absence of inclusion of patients from surgical hubs may not represent the real-world variety of Italian dialysis center VA protocols.
Conclusion: Healthcare providers should discuss VA options and their impact on QoL, considering patients’ life goals and preferences.
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Copyright (c) 2026 Mangano S, et al.
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