IMPACT OF EDUCATIONAL INTERVENTION FOR PERMANENT ACCESS CREATION AND MORTALITY REDUCTION AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS IN LOW RESOURCE SETTINGS

Introduction:

Mortality during the first 90 days on chronic hemodialysis is several folds higher than the period before and after it.  In low-resource settings, these are compounded due to a combination of poor pre-end-stage kidney disease care, emergency initiation of hemodialysis, delay in permanent access creation, severe anemia and inadequate dialysis. Hence, we conducted this study to assess the effect of educational intervention for facilitating permanent vascular access creation and mortality reduction among patients on maintenance hemodialysis.

Methods:

We included 21 centres in this study under a public-private partnership dialysis program provided by a single large dialysis network in India. The study period was from October 2023 to June 2024. The educational intervention was done in all 21 centres. All clinical staff, patients and attendees were educated about the processes of catheter care during the session and at home respectively and the benefit of early arteriovenous fistula (AVF) access. However, in addition, we also facilitated referral to proximal hospitals to create AVF surgery in 9 centres among 21 centres. We descriptively present facility-level data on the number of patients registered for dialysis, their vascular access status at the end of each month and early mortality (i.e., death during the first three months of the start of dialysis) recorded during the study period in 9 centres (intervention centres with both education and referral) and also the AVF conversion rate in 12 centres (regular centres with education only). Data collection and analysis was done using Microsoft Excel.

Results:

The number of patients registered cumulatively in 9 centres from October 2023 to June 2024 is shown in figure 1. Following the educational intervention, the proportion of patients on catheters at the end of each month decreased from 14% to 7%. The proportion of deaths among patients with catheters decreased from 35% to 30%. Early mortality rate decreased from 7% to 5% (Figure 1). We also descriptively compared the proportion of AVF conversion rate in 9 intervention centres with 12 regular centres shown in Figure 2. The AVF conversion rate increased from 17.4% to 38.2% in intervention centres and from 16.8% to 44.3% in regular centres.

Conclusions:

Educational intervention in catheter care and facilitatory actions for AVF creation show a trend in the improvement of permanent access creation. There is a spillover beneficial effect even in centers without referral facilitation too. Impact on mortality was difficult to assess due to confounding factors secondary to comorbidity and age.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.