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In many countries as Peru, there is a high prevalence of central venous catheter (CVC) use with many complications associated. In this report, it was reviewed the gap between the demand and supply on vascular access (VA) regarding CKD prevalence, health systems, availability of health workforce, and multidisciplinary equipment. Data from Peru was compared to Latin America because there is an effort to improve the care on VA in this country. In Peru, hemodialysis, HD (85.9%) is the predominant renal replacement modality. The native arteriovenous fistula (nAVF) use in the prevalent Peruvian population (24%) is lower than in Argentina (67.6%) or Uruguay (47.6%).
Narrative review. A broad literature review of VA epidemiology data, the national health systems, and key stakeholders (national nephrology societies).
1. The gap between demand and supply
Peru has a population of 32.5 million at 2019 with a prevalence of dialysis-dependent CKD of 974 per million inhabitants (pmp). In 2016, Peruvian Social Security reported 10,710 patients being treated with dialysis with 7,778 receiving coverage from public health insurance.
Peru has a tripartite health system: public (61%), social security (33%), and private (4%). The health per capita cost was $626 in 2016, lower than Chile and Uruguay. The rate of nephrologists is 1.7 ppm, while in Latin America has been reported 19 ppm in 2019 (the recommendation of the Pan-American Health Organization is 20 ppm)8-10. In 2022 there was 565 nephrologists, 302 cardiovascular surgeons, and 13 interventional radiologists.
In Peru, most of the HD population is centralized in cities such as Lima. The demand for nAVF creation from the incident population is 27 patients per month at one national referral Hospital, which would require attention by vascular surgery for 2-3 shifts per week, however, the priority is directed for other procedures (figure 1). Further, there is a previous late referral. In case of interventional radiology, there is a demand for other procedures, hence, there is deferral attention for all VA procedures including angioplasty or thrombectomy. Additionally, many patients need a cavography before the nAVF creation because of central venous occlusion, however, many nephrology departments did not have c-arm fluoroscopy or training for using it
Figure 1.
The integrative multidisciplinary perspective in VA is a fundamental part to optimize the supply of a continuous demand of patients for the creation of nAVF. Appropriate distribution of responsibilities can reduce the disparities by segmented health systems or reduced number of specialists.