Vascular Access for Hemodialysis in Sub-Saharan Africa: Patterns, Complications, and Gaps in Evidence – A Narrative Review

Vascular access is a critical determinant of outcomes in hemodialysis, with arteriovenous fistulas (AVFs) offering superior patency and lower complication rates compared with arteriovenous grafts (AVGs) and central venous catheters (CVCs).Despite strong international recommendations favoring AVFs, catheter dependence remains disproportionately high in sub-Saharan Africa.This narrative review synthesizes current evidence on patterns of vascular access use, associated complications, and management strategies in sub-Saharan Africa, with a focus on identifying gaps relevant to low-and middle-income settings.A narrative review of published literature was conducted, focusing on epidemiology, patient outcomes, complication profiles, and access management strategies related to hemodialysis vascular access globally and within sub-Saharan Africa.Available evidence demonstrates marked regional disparities in vascular access utilization.While high-income countries report increasing AVF prevalence, most African dialysis centers remain heavily reliant on catheters, largely due to late nephrology referral, limited surgical capacity, and health system constraints.Catheter use is consistently associated with higher rates of infection, thrombosis, hospitalization, and mortality.Data on AVF maturation, patency, and long-term outcomes in Africa remain sparse, and reported complication rates appear higher than in high-income settings.There is a substantial evidence gap regarding vascular access outcomes in sub-Saharan Africa.Context-specific data are urgently needed to guide policy, improve access planning, and reduce catheter dependence.This review underscores the importance of regionally grounded research to inform quality improvement and align practice with global standards.