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Current state of dialysis access management in Korea
Yong-Soo Kim1, Yaeni Kim2, Seok Joon Shin2
11 Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea.
Insights
Hemodialysis and kidney transplants are increasing, while peritoneal dialysis declines. Nephrologists are now key in managing vascular access, improving timely creation and adherence to guidelines for dialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Increasing prevalence of hemodialysis and kidney transplants, contrasting with declining peritoneal dialysis rates since 2006.
- Dialysis patient population is aging and requires longer-term dialysis, with diabetic nephropathy as the primary cause of end-stage renal disease.
- Hemodialysis vascular access types remained stable: arteriovenous fistulas (76%), arteriovenous grafts (16%), and central venous catheters (8%) in 2016.
Purpose of the Study:
- To analyze trends in dialysis modalities and patient demographics.
- To examine the types and insertion methods of vascular access for hemodialysis and peritoneal dialysis.
- To investigate the evolving roles of nephrologists, surgeons, and radiologists in vascular access management.
Main Methods:
- Retrospective analysis of dialysis patient data and vascular access procedures.
- Review of surgical and interventional radiology techniques for dialysis access.
- Tracking of changes in physician involvement in vascular access creation and management.
Main Results:
- Hemodialysis and kidney transplant rates increased; peritoneal dialysis rates decreased since 2006.
- Arteriovenous fistulas dominated hemodialysis access (76%), while surgical insertion was common for peritoneal dialysis catheters (67%).
- Nephrologists' involvement in vascular access management, including catheter insertion and interventions, has grown, leading to decreased central venous catheter use and increased timely, guideline-adherent access creation.
Conclusions:
- The management of dialysis vascular access is shifting, with increased nephrologist participation.
- Improved timeliness and adherence to international guidelines in vascular access creation are evident.
- These changes reflect a coordinated effort to optimize dialysis patient care and outcomes.
Abstract:
The prevalence rate and the incidence rate of hemodialysis and functioning kidney transplant recipients have continuously increased; on the contrary, those of peritoneal dialysis have continuously decreased since 2006. Dialysis patients have been getting older and have been maintained on dialysis longer. Diabetic nephropathy was the leading cause of end stage renal disease. The type of hemodialysis vascular access has been stable during the last 5 years (arteriovenous fistulas 76%, arteriovenous grafts 16%, central venous catheters 8% at 2016). Peritoneal dialysis catheter was mostly inserted surgically (67%), and swan neck straight tip peritoneal dialysis catheter was the most commonly used (48%). Vascular access was managed by radiologists and surgeons, and the management was fragmented among them in the past. However, since the nephrologists became interested in and knowledgeable about the vascular access, they began to play roles in vascular access management. Vascular access has been mostly created by vascular surgeons (≈60%); tunneled central venous hemodialysis catheter insertion and endovascular intervention such as percutaneous transluminal angioplasty (PTA) and thrombectomy have been mostly performed by radiologists (≈70%). Tunneled hemodialysis catheter insertion and endovascular intervention by nephrologists have slowly but consistently increased. Recently, the number of central venous hemodialysis catheter insertion has decreased, and tunneled hemodialysis catheter has been inserted more than non-tunneled hemodialysis catheter, indicating that vascular access has been created timely and the vascular access team has been educated about and following international guidelines.
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