MO764: Type of Vascular Access in Incident Hemodialysis Patients in Morocco: Predialysis Nephrology Care Should be Improved

Abstract

Abstract BACKGROUND AND AIMS Current guidelines recommend early placement of an autogenous arteriovenous fistula (AVF) before initiation of chronic hemodialysis therapy. Also, several studies showed that optimal pre-dialysis care is crucial to prepare a functioning permanent dialysis access. However, despite these recommendations, incident patients in Morocco usually initiate dialysis therapy using temporary catheters. Therefore, the purpose of our study was to identify the types of vascular access used by incident hemodialysis patients in Morocco and to determine the effect of pre-dialysis renal care on native AVF utilization. METHOD We conducted a cross-sectional study at the nephrology department of Mohammed VI university hospital from January 2019 to January 2021 among adult incident hemodialysis patients. Clinical and demographic characteristics, as well as data on vascular access type and nephrology care prior to dialysis initiation, were recorded. RESULTS A total of 210 patients were enrolled in our study. The mean age of the participants was 51.6 ± 12.3 years (19–78) with a male predominance (71.4%). The leading cause of the end-stage renal disease (ESRD) was diabetic nephropathy in 41.4% of the patients. At hemodialysis therapy initiation, 173 patients (82.4%) were dialyzed using a temporary central venous catheter (CVC), 20 (9.5%) with a tunneled hemodialysis catheter (TDC) and 17 (8.1%) with an AVF. Out of all participants, only 81 (38.5%) received prior nephrology care. Patients who reported being seen by a nephrologist at least 1 month before starting hemodialysis therapy (75%) were more likely than those referred later to use an AV access at initiation (22.2% versus 1.5%; P < 0.001). This association remained significant after adjustment for age, sex, geographical origin, education, insurance coverage, comorbidity status and underlying renal diagnosis. CONCLUSION Our findings showed a high incidence of CVC use among incident hemodialysis patients which is contrary to all recommendations. Also, we found that patients who received pre-dialysis nephrology care were significantly more likely to start their HD through AVF. Therefore, further efforts to improve both referral patterns and preparation for dialysis after referral are needed.