Artificial Intelligence and Sensing Technologies for Vascular Access in Hemodialysis: A Narrative Review.

Vascular access performance determines the adequacy, safety, and cost of hemodialysis. Stenosis, thrombosis, cannulation difficulty, infection, and access-related cardiac stress remain major sources of morbidity. This narrative review examines artificial intelligence and sensing technologies for vascular access care, based on PubMed and ClinicalTrials.gov searches through 22 August 2026 with citation chaining. Existing reviews have examined artificial intelligence in dialysis broadly or prediction models in isolation. In this review, the vascular access itself is kept as the unit of analysis, and the evidence is followed across four connected stages: systemic risk stratification; prediction of maturation, dysfunction, and complications from clinical, ultrasound, and multimodal data; longitudinal monitoring with optical, acoustic, vibration, thermal, and pressure sensors; and procedural support with robotics and visualization technologies. Reported discrimination is high in retrospective, recording-level analyses, reaching areas under the curve of 0.99 and sample-level accuracy of 100%, but falls to approximately 0.71 in longitudinal designs that predict future events in the same patients; patient-level external validation and calibration are also rarely reported. No approach has yet been demonstrated to reduce thrombosis, prolong patency, avoid interventions, or lower cost relative to standard care in prospective multicenter studies. Deployment is further constrained by power budgets, duty cycling, and transmission bandwidth in wearable devices. Technical feasibility should not be read as clinical utility.