Abstract
To determine frequency of different vascular access use in Incident hemodialysis (HD) patients and determine whether predialysis care in terms of timely advice for vascular access placement was better in the hands of nephrologist. A cross sectional study was conducted. Data was collected on the type of access used for first HD, including temporary Central venous catheters (CVC), permanent CVC (Permacath), arteriovenous fistula (AVF), or arteriovenous graft (AVG). In addition, information was also gathered if patients were aware of their renal disease and was followed by other physicians or nephrologist. A total of 120 patients were enrolled in the study, 80% required CVC as their first access for HD (96/120 patients) out of which 74.2% were dialyzed through temporary catheter and 5.8% through Permacath. About 20% of patients were dialyzed through mature Arteriovenous (AV) access. Majority (95.8%) of patients were being followed by any health care provider. 68% of them were aware of their renal disease. About 55.8% were referred to nephrologist and 40% were followed by other physicians. About 83.5% of patients followed by nephrologist were advised AV access prior to commencing HD, compared to only 10.4% followed by other physicians (p<0.05). 24/61 (39.3%) patients that were advised AV access by both groups had timely made AV access and underwent HD by it. Very high incidence of temporary HD catheter was used in Incident HD patients. Moreover, pre dialysis care in terms of placement of AV access prior to initiating HD is better in the hands of nephrologist and patients should be timely referred to nephrologist especially when they have Stage 4 chronic kidney disease (CKD).
Highlights
An adequate vascular access for patients with End Stage Renal Disease (ESRD) on hemodialysis (HD) is one of the most important challenges that a nephrologist faces
Vascular accesses available for HD include arteriovenous fistula (AVF), arteriovenous graft (AVG), central venous catheters (CVC), both temporary and permanent (Permacath) that can provide adequate HD, each of them have their limitations and advantages
We conducted this study in Pakistan to determine frequency of different vascular access use in Incident HD patients and determine whether predialysis care in terms of timely advice for vascular access placement was better in the hands of nephrologist
Summary
An adequate vascular access for patients with End Stage Renal Disease (ESRD) on hemodialysis (HD) is one of the most important challenges that a nephrologist faces. DOQI guidelines recommend use of AVF over AVG due to lower risk of complications.[6] Since CVC are associated with higher complications including increased risk of cardiovascular complications[11,12,13,14,15] and mortality,[16] their use should be limited with timely referral to nephrologist and surgeon so that AVF can be created and enough time is available for it to mature, as late creation can result in high failure rate.[17] Enough evidence exists that late referral to a nephrologist of patients with chronic renal failure results in increased morbidity and mortality.[18]
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