Central vascular access in kidney and cancer care: devices, biomaterial strategies, and prevention of complications

Chronic kidney disease (CKD) and cancer are among the most prevalent chronic conditions that increasingly demand reliable long-term central venous access devices (CVADs), including central venous catheters (CVCs), peripherally inserted central catheters (PICCs), and implantable ports (PORTs). Despite their essential role, CVAD-related complications, primarily infections and thrombosis, continue to compromise patient safety and burden healthcare systems, remaining a major challenge. Beyond patient- and procedure-related factors, device-intrinsic characteristics such as material composition, surface properties, and design features critically determine thrombogenicity, infection risk, and overall performance. This review provides recent advances in CVAD biomaterials, emphasizing surface engineering strategies aimed at antimicrobial activity, antithrombogenicity, and multifunctional performance. Antimicrobial coatings, antithrombogenic surfaces, and novel polymeric designs demonstrate promising potential to mitigate infection and thrombotic events. However, most innovations are currently unfunctional or lack long-term clinical validation, and their translation into practice is constrained by challenges in standardization, durability, and multifunctional integration. CKD and cancer populations are presented as case studies to illustrate how targeted biomaterial design and engineering can optimize device outcomes. Finally, we discuss future perspectives, emphasizing the need for interdisciplinary biomaterials research combining materials science, engineering, and clinical expertise to develop durable, multifunctional CVAD surfaces that enhance safety, extend device longevity, and reduce the healthcare burden associated with long-term vascular access in high-risk patients.