Introduction:
The number of patients with End-stage kidney disease (ESKD) has steadily risen in the past decade and so has the number of health institutes offering maintenance hemodialysis services to the patients. Vascular access (VA) is the lifeline of these patients without which the patients cannot receive hemodialysis and is so vulnerable to damage that it is often referred to as the Achilles heel of hemodialysis. So, there is a need for a skilled team of health workforce who have to create vascular access, take good care of vascular access, and tackle problems with vascular access for the longevity of the vascular accesses. Any problem with vascular access causes a severely negative impact on the delivery of hemodialysis and the overall health of the patients and for the best outcome, the involvement of nephrologists is unquestionable.
This study aimed to evaluate the prevalence of vascular access types, workforce involvement, and nephrologist participation in vascular access management in Nepal.
Methods:
This nationwide survey encompassed all 86 hemodialysis units listed in the Information Management System for Medical Management of Poor Citizens across Nepal. Utilizing a RedCap-based online questionnaire, we gathered data from 62 responding units, representing 4,508 patients.
Data on vascular access types, personnel involved, and resources were collected.
Additionally, an online survey was conducted among Nepali nephrologists to assess their training and practice related to vascular access.
Results:
The finding related to the prevalence of vascular access in Nepal was encouraging with a high prevalence of arteriovenous fistulas (AVF). Among the patients surveyed, 88.9% of the patients had functioning AVF at the time of the study. The usage of arteriovenous graft (AVF) was minimal (0.18%). Non-tunneled catheters comprised 7.38% and tunneled catheters accounted for 3.1%.
Most of the centers had resources to create AVF (60%) which were almost exclusively done by vascular surgeons and 85% of the centres had resources to place non-tunneled catheters but only 45% were by nephrologists. Tunneled catheters could be placed in 30% of the centres and are mostly done by vascular surgeons.
The involvement of nephrologists in vascular access management did not seem encouraging. Though all the nephrologists had received training for temporary catheter placements, only 72% were putting the catheters themselves. The training for placement of tunneled catheter and AVF was a mere 44% and 22%, respectively. Only 17% of the nephrologists and 5% of the nephrologists created AVF. The reasons stated by the nephrologist for not participating in vascular access management were lack of adequate training and lack of time.
Conclusions:
This study highlights the need for improved nephrologist participation in vascular access management in Nepal. While AVF utilization is high, resource limitations and personnel involvement may impact patient outcomes. Enhancing nephrologist training and involvement in vascular access procedures is crucial for optimizing care for ESKD patients
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.