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There is a lack of contemporary data describing variations in vascular access for hemodialysis (HD) among world regions. Our aim was to highlight differences in funding, availability, and pattern of use for vascular access used in hemodialysis initiation across world regions using the third iteration of International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA).
An electronic survey was sent to national and regional key stakeholders affiliated with ISN between June and September 2022. Countries participating in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Survey questions were directed at understanding vascular access use, availability, and funding.
Data on types of vascular access was available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG), with higher use in Western Europe (n=14; 64%), North & East Asia (n=4; 67%), and high-income countries (n=24; 38%). The proportion of > 50% of patients starting HD with a tunneled dialysis catheter was highest in North America & Caribbean region (n=7; 58%) and lowest in South Asia and Newly Independent States and Russia. Respondents from 50% (n=9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest proportion in Africa (n=20, 50%) and Latin America (n=10; 48%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n=42; 67% for AVF/AVG, n=44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n=8; 40% for AVF/AVG, n=5; 25% for central venous catheters). Countries in North America tended to have tunneled dialysis catheter as the dominant access for HD initiation, whereas countries in Western Europe, China, and Russia used AVF/AVG as the dominant access modality for HD initiation. In Africa, Latin America, and South Asia, temporary catheters (compared to other access types) were more frequently used to initiate HD.
There is substantial global variability in the types of vascular access used to initiate hemodialysis and in the funding models for vascular access creation. In high income countries, variations in AVF/AVG vs tunneled catheter use are not fully explained by national income status or resource availability. In low-income countries, and the ISN regions of Africa and Latin America, there is a higher use of temporary dialysis catheters and private funding models for access creation.