Factors Associated with Current Catheter Use Among Maintenance Hemodialysis Patients in Southern Iraq: A Cross-Sectional Study of Initial Vascular Access and Dialysis Vintage

Abstract

Relative to arteriovenous fistulas (AVFs), central venous catheters carry a greater risk of infection, cardiovascular complications, and mortality, and guidelines recommend minimizing their use. In Iraq most patients start hemodialysis through a catheter, but the factors that keep prevalent patients catheter-dependent have not been studied. This cross-sectional analysis included all 394 adults receiving maintenance hemodialysis in the five units of Thi-Qar Governorate between September 2025 and January 2026. Demographic, comorbidity, and dialysis characteristics of patients currently receiving dialysis via a catheter were contrasted with those of AVF users. Independent correlates of current catheter use were identified by multivariable binary logistic regression. At the time of study, 183 patients (46.4%; 95% CI 41.6–51.4) were dialyzing through a catheter and 211 through an AVF. The two groups were comparable in age, sex, residence, known CKD duration, diabetes, hypertension, cardiovascular disease, and number of weekly sessions. Catheter users had a much shorter dialysis vintage (11.7 ± 18.2 vs. 35.1 ± 27.8 months; p < 0.001). Of the 342 patients who started dialysis through a catheter, 195 (57.0%) had converted to an AVF, whereas 36 of the 52 patients (69.2%) who started with an AVF were now using a catheter. In multivariable analysis, each additional year of dialysis vintage halved the odds of catheter use (aOR 0.49 per 12 months; 95% CI 0.41–0.59), and patients who had started with an AVF had about five-fold higher odds of current catheter use than those who had started with a catheter (aOR for catheter start 0.19; 0.09–0.41). No demographic or comorbid characteristic was associated with catheter use. In Thi-Qar, catheter dependence is clustered in the early years on dialysis and among patients who initiated dialysis with an AVF, and it is not explained by patient comorbidity. Earlier fistula creation and surveillance of maturing and established fistulas should be priorities for hemodialysis services in southern Iraq.