Interventional nephrology in Puerto Rico: a four year experience

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• Puerto Rico has a high prevalence of Medicare patients requiring renal replacement therapy.
• Vascular access is critical for hemodialysis in patients with chronic kidney disease.
• Analysis of interventional procedures for vascular access was conducted between June 2007 and August 2010.

Purpose of the Study:

• To analyze the management and success rates of interventional procedures for vascular access in Puerto Rico.
• To evaluate the effectiveness of vascular access procedures based on Society of Interventional Radiology (SIR) criteria.
• To highlight the need for educational programs for vascular access in chronic kidney disease patients.

Main Methods:

• Retrospective analysis of 3755 patients undergoing vascular access procedures.
• Categorization of vascular access types: intravascular catheters (58%), arteriovenous fistulas (28%), arteriovenous grafts (15%).
• Evaluation of procedure success rates using SIR criteria for Lifeline Vascular Access, including declots, catheter placement, and angioplasty.

Main Results:

• The study analyzed 3755 patients, with intravascular catheters being the most common access type (58%).
• Key procedures included catheter introduction (33%), angioplasty (20%), and angiography (12%).
• An overall success rate of 98.2% was achieved, exceeding the KDOQI/SIR standard of >85%.

Conclusions:

• Vascular Interventional Nephrology Center at Auxilio Mutuo Hospital demonstrated a high success rate in vascular access procedures.
• Sustaining high success rates requires ongoing effectiveness evaluation.
• Development of educational programs for vascular access in chronic kidney disease patients is crucial prior to dialysis initiation.