Predialysis nephrology care amongst Palestinian hemodialysis patients and its impact on initial vascular access type

Abstract

Referral time for end-stage renal disease (ESRD) patients to nephrologists and initial vascular access method are considered significant factors that impact health outcomes at the time of hemodialysis (HD) initiation. Native arteriovenous fistula (AVF) is strongly recommended as initial access. However, little is known about the referral rate among ESRD receiving HD in Palestine and its correlation with AVF creation. In Ramallah Hemodialysis Center, we investigated the predialysis nephrology care and AVF usage in 156 patients. Type of access at HD initiation was temporary central venous catheter (CVC) in 114 (73%), tunneled hemodialysis catheter (TDC) in 21 (13%) and AVF in 21 (13%). Out of all participants, 120 (77%) were seen by nephrologist prior to dialysis. Of the participants who initiated dialysis with a CVC, 36 (31%) had not received prior nephrology care. All participants who initiated dialysis with functional AVF had received prior nephrology care. Patients who were not seen by a nephrologist prior to HD initiation had no chance at starting HD with AVF, whereas 17% of those who had nephrology care >12 months started with AVF. In conclusion, a relatively large percentage of Palestinian HD patients who were maintained on HD did not have any predialysis nephrology care. In addition, patients who received predialysis nephrology care were significantly more likely to start their HD through AVF whereas all those without predialysis nephrology care started through CVC. More in-depth national studies focusing on improving nephrology referral in ESRD patients are needed to increase AVF utilization.

Endovascular Intravascular Intervention for Central Venous Stenosis in Maintenance Hemodialysis Patients: a Retrospective Observational Study

“…Although there was a signi cant increase in hemodialysis patients with arteriovenous stula (AVF), most patients at the initiation of hemodialysis need to be placed on a temporary catheter. Atieh AS et al [4] . reported that temporary central venous catheters were used in 73% of hemodialysis patients, 13% with tunneled hemodialysis catheters, and 13% with AVF at hemodialysis initiation in the Palestinian hemodialysis center.…”

“…It is estimated that there were more than 2 million dialysis patients worldwide in 2010, and modelling data show that this number will more than double by 2030 [1,2] . Although there has been a signi cant increase in hemodialysis patients, most of the patients at the initiation of hemodialysis need to be placed on a temporary catheter in developed or developing countries [3,4,5] . Due to temporary catheterization at hemodialysis initiation, there are more clinical problems associated with vascular access in patients undergoing hemodialysis.…”

Patient engagement during the transition from nondialysis‐dependent chronic kidney disease to dialysis: A meta‐ethnography

“…The patients' goals and preferences regarding treatment modality and access should be incorporated into the medical consultation 8‐10 . However, transitional care during the peridialysis period is inadequate and can result in an unplanned or emergency initiation of dialysis 11,12 …”

“…[8][9][10] However, transitional care during the peridialysis period is inadequate and can result in an unplanned or emergency initiation of dialysis. 11,12 Patient engagement is defined as the desire and capability to actively participate in care in a way uniquely appropriate to the individual, in collaboration with healthcare providers, to maximize outcomes and improve the experiences of care. 13 Patient engagement reflects the core value of person-centred care, in which patients are encouraged to be actively involved in processing information, making and acting on decisions and managing self-care.…”

“… 8 , 9 , 10 However, transitional care during the peridialysis period is inadequate and can result in an unplanned or emergency initiation of dialysis. 11 , 12 …”