Arteriovenous Access Shows Lower Mortality Risk Than Catheters in Hemodialysis

Hemodialysis remains the primary renal replacement therapy for the vast majority of patients with end-stage renal disease [1, 2]. While clinical guidelines emphasize the use of arteriovenous fistulas or grafts, many patients initiate treatment with central venous catheters due to late diagnosis or vascular exhaustion [1, 3]. These catheters are frequently associated with complications such as venous stenosis and systemic infections, which can escalate to life-threatening conditions like sepsis or infective endocarditis [1, 4, 5]. Despite the established preference for permanent access, the degree to which access type independently dictates survival remains a subject of intense clinical debate [2]. A large-scale retrospective analysis now clarifies the survival differences between these modalities, carefully weighing whether the higher mortality seen in catheter users is caused by the device itself or the underlying frailty of the patients who receive them.