Comparative Analysis Of Vascular Access For Haemodialysis In End-Stage Renal Disease In A Developing And Developed Country.

Abstract

Background: End Stage Renal disease (ESRD) is an important and growing medical problem all over the world especially in developing countries. Securing adequate vascular access is an essential part of managing affected patients. Objectives: To compare vascular access routes for haemodialysis in a developed and developing country setting.Method: Case notes were studied for information on age, gender, vascular access routes at University of Nigeria teaching hospital (UNTH) from January to July 2000. Operation lists and case notes used at Texas Heart Institute (THI) from October 2005 to March 2006 were reviewed to provide the above information. The findings were compared. Result: One hundred and fifty nine and Ninety four patients at THI and UNTH respectively were studied. There was similar gender pattern among patients seen at both institutions. The mean age in years of patients with ESRD requiring haemodialysis was lower at UNTH (44.6±17.1 as against 56.2±14.8 in THI), p<0.001. Direct femoral vein cannulation was the main vascular access route in UNTH (93.6%), whereas left hand arteriovenous graft (AVG) was the commonest route at THI (34.6%). Conclusion: We conclude that the prevalent vascular routes differ in these two centers with THI having a well established renal replacement protocol. The important challenges at UNTH include inadequate manpower, general poverty of the patients, lack of vascular access creation materials and unavailability of organized health policy for patients with ESRD in Nigeria. These problems are common in most developing countries. This paper was presented at the 51 st Annual General Meeting and Scientific Conference of West African College of Surgeons, Dakar Senegal on July 3, 2011.