Arteriovenous fistula outcomes in Malaysia: A systematic review and meta-analysis of maturation, failure and patency rates

Arteriovenous fistulas (AVFs) remain the preferred vascular access for haemodialysis globally. Malaysia has a rapidly rising burden of end-stage renal disease (ESRD), but reported AVF outcomes vary across institutions, and no national synthesis has previously been performed. This review aimed to evaluate AVF outcomes in Malaysia, consolidate available evidence, and provide baseline reference values to guide future access planning and research. A systematic search of PubMed, Scopus, Web of Science, Google Scholar and Malaysian databases was conducted from inception to June 2025. Eligible studies reported outcomes of native AVFs in Malaysian populations. The primary outcome was 12-month primary patency. Secondary outcomes included primary failure (early thrombosis or non-maturation), maturation at ~6 weeks, complications and predictors of outcome. Random-effects meta-analysis was used. Risk of bias was assessed using RoB 2 and ROBINS-I. Twelve studies (<i>n</i> = 1426 patients) were included: two randomized trials and ten observational cohorts. The pooled 12-month primary patency rate was 73.5% (95% CI, 62.4%-84.6%; <i>I</i>² = 93%, considerable heterogeneity). The pooled primary failure rate was 19.3% (95% CI, 14.1%-24.5%; <i>I</i>² = 69% - substantial heterogeneity), and pooled early maturation was 84.2% (95% CI, 78.1%-90.4%; <i>I</i>² = 73%, substantial heterogeneity). Upper-arm AVFs demonstrated consistently higher maturation than forearm sites. Diabetes, small vessel calibre and central venous catheter dependence were the most common predictors of poor outcome. Intraoperative heparin significantly reduced early thrombosis (RR 0.36; 95% CI, 0.13-0.99), whereas fish oil and aspirin had no measurable benefit. Complication profiles resembled international reports, dominated by stenosis and thrombosis. Malaysian AVF outcomes demonstrate favourable early maturation and acceptable 12-month patency, consistent with international experience despite a high comorbidity burden. These data provide the first consolidated national benchmark for vascular access outcomes in Malaysia and highlight priorities for future multicentre collaboration, surveillance strategies and standardized reporting.