Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia

Abstract

South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.

Arteriovenous fistula creation by nephrologist and its outcomes: a prospective cohort study from Vietnam

“…In contrast, a nationwide study conducted on 388 nephrologists in India to examine the current vascular access practices among nephrologists found that less than 25% of their ESRD patients started hemodialysis with AVF [ 27 ]. Similarly, in the Philippines, most CKD patients have unplanned initiations of hemodialysis treatment, and only 24% of incident hemodialysis patients start their treatment with AVF [ 9 , 28 ]. Indeed, in Vietnam, a previous study conducted at the same study clinic reported that the rate of AVF creations before hemodialysis initiation was also low at 6.44% [ 6 ].…”

“…In our study, the primary AVF failure rate was 13.13% (13/99, 95%CI: 8.74–21.18%). In the Philippines, the reported primary AVF failure rate was less than 3% [ 9 ]. AVF creations are mainly performed by vascular surgeons, while less than 1% of nephrologists has been involved in interventional procedures including AVF creations [ 9 ].…”

“…In the Philippines, the reported primary AVF failure rate was less than 3% [ 9 ]. AVF creations are mainly performed by vascular surgeons, while less than 1% of nephrologists has been involved in interventional procedures including AVF creations [ 9 ]. This is probably attributable to the low primary AVF failure rate in this country.…”

“…The management of vascular access in patients with CKD has not been standardized and mainly depends on the availability of human resources. In detail, in small hospitals and satellite dialysis centers, CKD patients are monitored for vascular access mainly by dialysis nurses due to shortages of both nephrologists and vascular surgeons [5,[7][8][9]. In large hospitals, nephrologists and dialysis nurses are responsible for this process, while vascular surgeon consultations are only available for selected, difficult cases [5].…”

Global Dialysis Perspective: Nepal

“…The proportions in the prevalent HD patients are 90% for AVF, 8% for non-TCC, and 1% for TCC. The use of an arteriovenous graft is <1% (13). With the advancements in the field of interventional nephrology in recent years, there has been an increasing trend of AVF placement performed by both vascular surgeons and nephrologists, with the goal of reducing the overall number of vascular catheters.…”