Abstract
Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites. Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant. Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.
Highlights
The worldwide prevalence of chronic kidney disease is estimated to be between 8% and 16%
Renal replacement therapy (RRT) in the form of dialysis or renal transplantation is life-saving for patients who progress to endstage renal disease (ESRD)
A cross-sectional, descriptive study was conducted between January 2016 and March 2016 at the renal unit of Kenyatta National Hospital (KNH), in Nairobi, Kenya, on patients 13 years or older who had been treated for ESRD with haemodialysis for at least one week
Summary
The worldwide prevalence of chronic kidney disease is estimated to be between 8% and 16%. In the year 2010, between 4.9 and 9.7 million people were estimated to require RRT; only 2.6 million received treatment. This treatment gap is fuelled by the growing populations from low-income nations in Africa and Asia. The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access
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