ASSESSMENT OF PAIN DUE TO VASCULAR ACCESS CANNULATION AMONG PATIENTS ON HEMODIALYSIS – A MULTI-CENTRIC CROSS-SECTIONAL STUDY IN INDIA, 2023

Introduction:

Globally, chronic kidney disease affects 10% of the population. As per 2022 reports, 4 million people are on kidney replacement therapy, hemodialysis being the most common form. Arteriovenous fistula is one of the most recommended vascular accesses for hemodialysis. Most patients on hemodialysis experience pain during needle insertion. This study aims to assess the severity of pain experienced due to cannulation and practices adopted to reduce pain.

Methods:

We conducted a multicentric cross-sectional study in 35 hemodialysis centres selected randomly from a single large private network that provides maintenance hemodialysis services in India. The study period was from September to October 2023. The total sample size was 2124. The patients who visited the centre to undergo hemodialysis in the selected centres and who consented to participate were included. The data was collected bedside, by trained, dedicated staff present in the hemodialysis centre using a laptop or a tablet. Data entry was done in a Google form and exported to Excel for analysis. We describe the basic demographic characteristics, patients' response to cannulation pain experienced during vascular access and practices adopted to reduce it.

Results:

Among 2124 study participants, the age ranged between 18 - 94 years, with a mean of 52.7 ± SD 13.92. 75% were males. 61% were from the south zone, 25% from the north and 14% from the west. 61% of the centres were located inside government hospitals and 39% were within private hospitals. 80% of the patients were covered by a government program, 8% by private insurance and 12% paid their medical expenses out-of-pocket. 99% of them were on arteriovenous fistula or graft at the time of interview. Based on the patient's responses, only 0.14% of them used buttonhole needles, majority, 99% used sharp needles. The rating of cannulation pain experienced by patients on a scale of 1 to 5 is shown in Figure 1. 36% had no pain, 43% had mild, 16% had moderate and 5% had severe pain. 8% of patients responded that cannulation pain bothered them or made them fear dialysis. 8% of them rarely reduced their frequency of dialysis sessions fearing pain and 1% reduced the frequency often. Majority of them did not use any therapeutic management for pain, 2% used thrombophob gel, 1% used anesthetic cream and 1% used local anesthetic injection. Among the respondents, 12% were willing to adhere to an increase in dialysis frequency if cannulation pain was lesser and 4% of them were willing to incur a “little” expenditure if there was a way to reduce pain during cannulation.      

Conclusions:

Cannulation with sharp needles is the dominant practice. Two-thirds experienced some pain and 20% at least moderate pain during cannulation. In a small proportion, cannulation pain caused fear of hemodialysis sessions and a lower compliance with the prescribed frequency of dialysis sessions. Interventions to decrease cannulation pain might increase dialysis frequency in a small proportion of patients.       

I have no potential conflict of interest to disclose.

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