“ACHILLES' HEEL" IN HEMODIALYSIS -VASCULAR ACCESS: A CROSS-SECTIONAL STUDY OF CONTEMPORARY VASCULAR ACCESS PRACTICES AND DIALYSIS ADEQUACY IN TERTIARY CARE CENTRE IN HYDERABAD, INDIA.

8 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-3559, Poster Board= SAT-319

Introduction:

Vascular access continues to be the modern “Achilles’ heel" in hemodialysis (HD). With the introduction of the fistula-first initiative, several countries changed their practices to perform hemodialysis using a functioning native arteriovenous fistula. However, in developing countries, there remains a significant variation in vascular access practices. The aim of this study is to capture a snapshot of contemporary vascular access practices and to analyze the adequacy of hemodialysis in our hospital.

Methods:

Type: Single-centre observational study conducted at ESIC Super Speciality Hospital, Hyderabad, India.

Sample Size: 291 patients undergoing regular dialysis at our centre were included over a period of 8 months.

Method: A standard proforma was used to collect data. The study results, including demographics, comorbidities, initial vascular access, current vascular access, and cannulation techniques, are presented in tables.

Inclusion Criteria: All end-stage renal disease patients aged 18 and above undergoing maintenance HD at ESIC hospital were included in the study.

Exclusion Criteria: Patients on peritoneal dialysis and those undergoing HD for acute kidney disease were excluded from the study.

Results:

This study represents the largest dataset of dialysis patients from a single institution. At our hospital, 204 (70.4%) of the patients undergoing hemodialysis (HD) were male, and 87 (29.5%) were female. Most patients had hypertension as a comorbidity (90.7%), followed by diabetes (41.5%), hypothyroidism (24.4%), coronary artery disease (12.7%), cerebrovascular disease (4.4%), peripheral vascular disease (1.7%) and COPD (1.7%).

     

KT/V value

>=1.2

154(53%)
 

<1.2

137(47%)

<1.2

RC fistula

87 (64%)
 

BC fistula

44(32%)
 

Basilic vein transposition

6 (4%)

Urea reduction ratio

>=65%

126 (43.4%)
 

<65%

165 (56.65)
     

                                                                                                                                                                                

PRESENTATION

COMORBIDITIES

ACCESS

SPEED

CURRENT ACCESS

Regarding HD duration 74(25.4%) patients had been undergoing HD for less than 1 year, 58 (19.9%) for 1–3 years, 58 (19.9%) for 3–5 years, 61 (21%) for 5–10 years, and 40 (13.7%) for more than 10 years. A total of 173 (59.6%) patients presented as "crash landers" for dialysis, while 118 (40.4%) presented for elective dialysis.

At the time of the study, 257 (88.6%) of our patients were dialyzed through functioning AV fistulas, which is above the national average. A recent survey reported that 30% of existing HD patients in India did not have a working AV fistula even after 3 months of initiating dialysis. Hemodialysis adequacy was assessed using the KT/V value, which revealed that 154 (53%) of patients in our center had a KT/V value greater than or equal to 1.2, while 137 (47%) had a KT/V value below 1.2, indicating inadequate dialysis. Among those with inadequate dialysis, 64% had a radiocephalic (RC) fistula, 32% had a brachiocephalic (BC) fistula, and 4% were dialyzed through a basilic vein transposition. Additionally, the urea reduction ratio (URR) was greater than 65% in 165 patients(56.6%), while 126(43%) had a URR less than 65%.Among fistulas ,Brachiocephalic fistula seems to be superior with respect to adequacy 

 

Conclusions:

Despite growing public awareness about chronic kidney disease (CKD) and HD, even among elective patients, 238 (81.8%) initiated their first HD using a central venous catheter (CVC), which highlights an area for improvement. These findings contrast with trends in other countries, where the use of arteriovenous (AV) fistulas at the time of first dialysis initiation is notably higher—84% in Japan, 58% in Europe, and 28% in the USA. The results indicate that while our vascular access practices are better than the national average, there is still room for improvement. Establishing a multidisciplinary team and dedicated vascular access coordinators could help enhance our current practices. Along with HD access greater importance must also be given for increasing the adequacy of the dialysis to decrease the uremic complication and decrease the mortality and morbidity.

I have no potential conflict of interest to disclose.

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