Comparative profile between catheters and arteriovenous fistulas for hemodialysis in Brazil

Introduction: Vascular access is a key determinant of the quality and safety of hemodialysis treatment. Despite the well-recognized superiority of arteriovenous fistulas (AVF), there are still gaps in the Brazilian literature regarding the patterns of use and clinical outcomes associated with each type of access. This study aimed to comparatively analyze the use of central venous catheters (CVC) and AVFs in Brazil. Materials and Methods: This is an ecological, descriptive, and cross-sectional study based on secondary data extracted from the Brazilian Unified Health System Outpatient Information System (SIA/SUS) through TabWin/DATASUS. Outpatient admissions for AVF creation between January 2008 and December 2024 were included. The analysis considered demographic, clinical, and transplant eligibility variables, as well as hospital mortality per admission (HMA). Results: A total of 7,067,387 admissions were analyzed, with a predominance of males (58.5%). AVF was the most frequently used access (65.1%), associated with lower mortality rates (9.24 per thousand), while CVCs were linked to higher mortality. Advanced age (≥80 years) and early childhood (<1 year) were identified as high-risk groups, and comorbidities such as hypertension, diabetes, and neoplasms showed significant correlation with admissions and deaths. Conclusion: AVF remains the safest and most effective form of vascular access, whereas catheters are associated with higher mortality, particularly in vulnerable populations with multiple comorbidities. A study limitation is the reliance on publicly available secondary data, which may be subject to underreporting.