Vascular Access for Hemodialysis in Sub-Saharan Africa: Patterns, Complications, and Gaps in Evidence – A Narrative Review
Abstract:
Vascular access
is a critical determinant of outcomes in hemodialysis, with arteriovenous
fistulas (AVFs) offering superior patency and lower complication rates compared
with arteriovenous grafts (AVGs) and central venous catheters (CVCs). Despite
strong international recommendations favoring AVFs, catheter dependence remains
disproportionately high in sub-Saharan Africa. This narrative review synthesizes current evidence on
patterns of vascular access use, associated complications, and management
strategies in sub-Saharan Africa, with a focus on identifying gaps relevant to
low- and middle-income settings. A
narrative review of published literature was conducted, focusing on
epidemiology, patient outcomes, complication profiles, and access management
strategies related to hemodialysis vascular access globally and within
sub-Saharan Africa. Available evidence
demonstrates marked regional disparities in vascular access utilization. While
high-income countries report increasing AVF prevalence, most African dialysis
centers remain heavily reliant on catheters, largely due to late nephrology
referral, limited surgical capacity, and health system constraints. Catheter
use is consistently associated with higher rates of infection, thrombosis,
hospitalization, and mortality. Data on AVF maturation, patency, and long-term
outcomes in Africa remain sparse, and reported complication rates appear higher
than in high-income settings. There is a substantial evidence gap regarding
vascular access outcomes in sub-Saharan Africa. Context-specific data are
urgently needed to guide policy, improve access planning, and reduce catheter
dependence. This review underscores the importance of regionally grounded
research to inform quality improvement and align practice with global
standards.
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