Perceived barriers and attitudes toward arteriovenous fistula creation and use in hemodialysis patients in Palestine

Abstract

In the dialysis center in Ramallah, we investigated the attitudes and perceived barriers to having arteriovenous fistula (AVF) in 156 patients. The current method of HD access was AVF in 52% and central venous catheter in 47%. Perceived causes of no or delayed AVF were: patient's refusal of AVF in 54.5%, late referral to a surgical evaluation in 31.3% and too long to surgical appointments in 14.2%. Among those who refused AVF, reasons were: concern about the surgical procedure in 42.5%, poor understanding of disease/access in 23.3%, fear of needles in 15.1%, denial of disease or need for HD in 17.8%, and cosmetic reasons in 1.4%. Forty six percent of patients believed they received education about AVF prior to the creation of HD access, and 73.7% would recommend AVF as the method of access due to the lower risk of infection (96%), easier to care for (16%), easier showering (14%), and better-associated hygiene (3%). In conclusion, the majority would recommend an AVF as the mode of vascular access for HD. The most common barrier to having an AVF was patient's refusal to undergo AVF creation because of their concern about the surgical procedure. A systematic evaluation of the process that precedes the creation of AVF may allow for better utilization.

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

“…Articles included 24 cross-sectional studies [ 1 – 3 , 25 , 26 , 28 – 30 , 33 , 36 , 37 , 39 – 45 , 47 , 50 – 52 ], one abstract of a literature review [ 38 ], one prospective cohort study [ 34 ], two case reports [ 31 , 48 ], one randomized controlled trial [ 24 ], and three reports [ 27 , 32 , 49 ]. The included studies used a variety of methodology to define and assess needle fear or phobia, ranging from a single question within a broader questionnaire, face-to face interviews to assessment of fear or phobia using a dedicated validated tool (eg.…”

Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

“…International Journal of Nephrology less adequate hemodialysis in this group of patients [12,13]. is may be due to higher initial BUN pre-HD in group A, but also probably can indicate the impact of Group A's prolongation of hemodialysis sessions, in hope of compensating for their fewer weekly hemodialysis sessions.…”

“…The mean of Kt / V in each hemodialysis session has been significantly more in Afghan patients compared with their Iranian counterparts; thus, technical failures such as arteriovenous fistula malfunction, can be excluded as a cause of less adequate hemodialysis in this group of patients [ 12 , 13 ]. This may be due to higher initial BUN pre-HD in group A, but also probably can indicate the impact of Group A's prolongation of hemodialysis sessions, in hope of compensating for their fewer weekly hemodialysis sessions.…”

Barriers to optimal vascular access for hemodialysis

“…While nonrandomized quality of life surveys have shown better scores in AVF/AVG patients than those with CVCs, 62 increasing numbers of patients have refused an optimal AVF or AVG to avoid the operative procedures, painful needle cannulations, more frequent needle cannulations on home HD, fear of needle dislodgement on nocturnal HD, and multiple procedures to maintain permanent accesses. 24,25,63,64 Cost considerations have entered into the decision of the optimal access primarily in the uninsured or undocumented immigrants, [50][51][52] with dialysis care of the latter group varying from state to state in the United States. 50 However, examination of cost-effectiveness reveals that the overall costs of patients with CVCs are the highest, whereas AVF costs are the lowest despite the initial higher costs of AVFs than AVGs.…”

“…However, patients with cardiovascular disease 17,30 or diabetes 30,61 have lower rates of successful AVF maturation. While nonrandomized quality of life surveys have shown better scores in AVF/AVG patients than those with CVCs, 62 increasing numbers of patients have refused an optimal AVF or AVG to avoid the operative procedures, painful needle cannulations, more frequent needle cannulations on home HD, fear of needle dislodgement on nocturnal HD, and multiple procedures to maintain permanent accesses 24,25,63,64 . Cost considerations have entered into the decision of the optimal access primarily in the uninsured or undocumented immigrants, 50‐52 with dialysis care of the latter group varying from state to state in the United States 50 .…”