Hemodialysis vascular access among chronic renal failure patients in Egypt.

Abstract

Proper choice of the vascular access plays a crucial role in dialysis outcome. The prevalence and types of vascular access have not yet been investigated in Egypt. Our work aims to study prevalence, patency rate, complications and factors affecting different types of vascular access in Egypt. We studied one thousand hemodialysis patients in eighteen dialysis centers in Egypt. 93% of the patients had natural arteriovenous access while 7% had synthetic arteriovenous grafts. The patency rate of natural fistulae was significantly higher than that of synthetic grafts (3.07 +/- 3 versus 1.5 +/- 2 years respectively). Many arteriovenous grafts were done because natural arteriovenous fistula was unsuitable or after its failure. Natural radiocephalic fistula was the most prevalent type (67.3%), with a patency rate significantly higher than all other sites (3.3 +/- 3 years). Only 10.2% of patients had a fistula created before the start of dialysis. Thrombosis rate was significantly higher in synthetic arteriovenous grafts (32.4%) than in natural arteriovenous fistulae (9.3%). Diabetes and hyperlipidemia significantly decreased the patency rate of natural arteriovenous fistula but not that of synthetic grafts. Patency of arteriovenous fistula in non-diabetics was 3.2 +/- 3.1 years versus 2 +/- 1.9 years in diabetics. Patency of arteriovenous fistula in non-hyperlipidemic patients was 3.1 +/- 3 years versus 1.5 +/- 1.6 years with hyperlipidemia. Temporary vascular access prior to permanent access was used in 90% of patients, of which femoral catheters were used in 53.6%, jugular catheters in 38% and subclavian catheters in 8.4%. The incidence of primary access failure was significantly higher in patients with a previous subclavian catheter insertion. Natural arteriovenous fistula is the access of choice for hemodialysis patients in Egypt. It has higher patency rate, lower complication rate and nephrologists prefer it. Diabetes and hyperlipidemia decrease patency rate of natural arteriovenous fistula but not synthetic grafts. Subclavian catheter is better avoided due to increased incidence of primary access failure.