Use of vascular access methods for hemodialysis in Serbia: Results from SerbVasc registry

Introduction: In many countries, hemodialysis is still the most common method of renal replacement. Significant regional variations exist in creating and maintaining vascular access for hemodialysis. Therefore, analyzing national registries with vascular access data is essential for developing effective national treatment strategies. The Serbian national vascular surgery registry was established as part of the VascuNet collaboration network in 2019. The registry comprehensively records vascular procedures across Serbia, including those related to vascular access for hemodialysis. Objectives: This study aims to evaluate the prevalence of different vascular access methods for hemodialysis in Serbia, focusing on both new and prevalent patients and examining demographic differences and risk factors. Patients and methods: The data were collected from the vascular accesses section of the SerbVasc registry over a 3-year observational period, focusing on the following aspects: number of incident and prevalent patients with types of vascular access, as well as comparison of patients with arteriovenous fistulas (AVF), arteriovenous grafts (AVG), central venous catheters (CVC), and tCVC based on age, gender, smoking, and comorbidities. Results: There were total of 1024 incident hemodialysis patients. AVF was created in 219 patients (21.4%), AVG in 5 patients (0.5%), and tCVC in 150 patients (14.6%), while hemodialysis via CVC was initiated in 650 (63.5%) patients. The total number of permanent vascular accesses for HD was 1402, comprising 686 (48.9%) distal AFVs, 220 (15.7%) proximal AVFs, 91 (6.4%) AVGs, and 405 (28.8%) tCVCs. The prevalence of current smoking was highest in the tCVC (48.3%) and lowest in the dAVF group (18.40%). Conclusion: The percentage of patients starting hemodialysis with AVF remains suboptimal. tCVC is used substantially as first and permanent access, particularly among older patients.