Tailoring Hemodialysis Access for Obese Patients: A Review of Current Evidence and Clinical Implications

Background: Obesity is increasingly prevalent in patients with end-stage renal disease (ESRD) and presents challenges for hemodialysis vascular access. This study aimed to evaluate different types of hemodialysis access in obese versus non-obese patients, focusing on clinical outcomes, ultrasound parameters, and dialysis adequacy.Methods: This was a retrospective study of 557 ESRD patients undergoing hemodialysis access creation at Mansoura University, Egypt. Patients were categorized into five access types: radiocephalic AVF (RC AVF), brachioaxillary arteriovenous graft (Br Ax AVG), brachiocephalic AVF (BC AVF), brachiobasilic AVF (BB AVF), and axillo-axillary loop AVG (AX AX Loop AVG). Demographic data, comorbidities, preoperative duplex ultrasound findings (including vein diameter, depth, and patency), laboratory data, and clinical outcomes (thrill presence, dialysis rate, time maintained on dialysis, complications, reintervention) were collected.Results: Obese patients were more likely to receive Br Ax AVG. Clinical assessment at 3 weeks, 3 months, and 6 months showed significantly better thrill outcomes in BB AVF (81.9% good thrill) and BC AVF (65.3% good thrill) compared to other types (RC AVF 38.2%, Br Ax AVG 34.8%, AX AX Loop AVG 0%). The rate of dialysis was highest in the BC AVF and BB AVF groups (median 900 mL/min). The longest mean time maintained on dialysis was in the BB AVF group (3.78 ± 0.63 hours). Complication rates (wound dehiscence, difficulty in cannulation, seroma/hematoma) were reported in BC AVF and BB AVF groups There was no statistically significant correlation between BMI and the rate of dialysis (r = 0.073, p = 0.086) or time maintained on dialysis (r = -0.044, p = 0.332).Conclusion: Obesity alone should not preclude arteriovenous fistula placement for hemodialysis access. While it may increase the technical difficulty of access creation and potentially complication/reintervention rates.