National Trends in Hemodialysis Vascular Access in Portugal: Insights from a Comprehensive Registry

Abstract

Introduction: Vascular access (VA) is a key determinant of outcomes in hemodialysis (HD). Real-world VA practice patterns are central to improving HD care, but few countries maintain national VA registries. The recent integration of a dedicated VA dataset into the Portuguese Society of Nephrology (SPN) Chronic Kidney Disease (CKD) Registry enables a detailed assessment of current national patterns.

Methods: Retrospective observational analysis of the SPN national CKD Registry, focusing on incident and prevalent HD patients in 2024 and 2025, complemented by temporal trends since 2014.

Results: A total of 2,209 and 2,203 patients initiated HD in 2024 and 2025, respectively. CVC use at HD initiation remained high (60.5% in 2024; 61.8% in 2025), continuing an upward trend over the past decade. Among prevalent patients, CVC prevalence rose from 19.2% to 20.4%, while arteriovenous fistula use declined slightly (73.3% to 71.9%). Substantial inter-center variability persisted, with 59 units reporting CVC rates higher than 20% at the end of 2025. Hospital-based units consistently showed higher prevalent CVC use than peripheral units. The VA thrombosis rate was 0.081 and 0.085 events per patient-year in 2024 and 2025, respectively.

Conclusion: CVC use in Portuguese HD patients remains high and continues to increase, particularly at dialysis initiation, despite recognition of its adverse impact. Substantial inter-center and inter-regional variability highlights important differences in practice patterns and ongoing structural challenges. These findings support the need for registry-driven benchmarking, monitoring of first VA at hospital level, and targeted national strategies tailored to regional realities.