The Use of Plastic Cannulas Versus Metal Cannulas in Arteriovenous Graft and Fistula: A Systematic Review and Meta-Analysis.

Abstract

Hemodialysis (HD) is a standard procedure for patients with end-stage renal disease, which utilizes arteriovenous fistulas (AVF) and grafts (AVG) for vascular access. Although plastic cannulas are emerging as cost-effective alternatives to traditional metal cannulas, there is limited evidence supporting their use in HD. This systematic review and meta-analysis aimed to compare dialysis adequacy and complications between plastic and metal cannulas for AVF and AVG access. A search identified randomized controlled trials (RCTs) published from 2018 to 2021 that focused on dialysis adequacy as the primary endpoint and vascular complications, such as infiltration and hematoma, as the secondary endpoint. Three studies involving 139 adult patients undergoing HD were included. Pooled analysis indicated that plastic cannulas were associated with a higher dialysis adequacy standardized mean difference (0.43), 95% confidence interval (CI [0.07-0.78]), P = .02, I2 = 0%, and fewer complications (risk ratios = 0.60, 95% CI [0.41-0.88], P = .009, I2 = 0%) than metal cannulas. These findings suggest plastic cannulas may be a more efficient and safer option for HD patients. Further RCTs are warranted to validate these results.