POS-600 Trends in vascular access types in hemodialysis patients in Ghana

Abstract

Usage and maintenance of an ideal Vascular Access (VA) is of optimum priority in hemodialysis patients. With data from the Komfo Anokye Teaching Hospital (KATH) nephrology clinic, a retrospective observational analysis was performed to evaluate the trends in vascular access types used for the different classes of hemodialysis patients in our country. This cross-sectional retrospective analysis of hemodialysis participant records was conducted at the nephrology clinic of KATH in October 2020. The records of 80 hemodialysis participants were used for this study. Sociodemographic and clinical data were obtained, organized and analyzed with Statistical Package for the Social Sciences (SPSS). Of the 80 participants enrolled, 65% were males, over 50% were aged ≥ 45 years and 87.8% were married. Majority (59.2%) of the participants were rural dwellers with 32.5% being traders and 27.5% unemployed. End Stage Renal Disease (ESRD) was the most prevalent (65%) condition at diagnosis followed by acute on Chronic Kidney Disease (CKD) (28.8%) and Acute Kidney Injury (AKI) (5.1%). Of the 35.5% who had been on dialysis for less than 3 months, 85.2% had Temporary Vascular Access (TVA) and 14.8% had Tunneled Venous Access (TUV). Whereas, of the 32.9% who had been on dialysis for over a year, 12% had TVA, 52% had Arteriovenous Fistula (AVF) and 36% had TUV. The dominant VA type was TVA (76.9%) in rural dwellers and AVF (80.0%) in urban dwellers with the internal jugular vein being the dominant (80.5%) site for catheterization. All AKI and majority of AKI/CKD participants (73.9%) had TVA. Most (40.3%) of the ESRD patients also had TVA. Although there was no significant association between sociodemographic data and type of VA used, we found a significant association between diagnosis as well as duration of dialysis and type of VA used. The number of chronic hemodialysis participants who had temporary vascular access was significantly higher than those with permanent vascular access, contrary to the general worldwide recommendations and are thereby at risk of complications associated with prolonged usage of temporary venous access.