Related Experiment Video
Updated: Jan 4, 2026
A Murine Model of Hemodialysis Access-Related Hand Dysfunction
Published on: May 31, 2022
Predialysis nephrology care and its impact on initial vascular access type in hemodialysis patients in Jordan
Abdurrahman M Hamadah1, Kamel Gharaibeh2
1Department of Internal Medicine, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
Insights
Early nephrology referral significantly increases arteriovenous fistula (AVF) use for hemodialysis (HD) in Jordan. Many patients initiating HD lacked prior nephrology care, resulting in central venous catheter (CVC) use.
Area of Science:
- Nephrology
- Vascular Access Surgery
- Public Health Policy
Background:
- Patients with chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) require timely nephrology referral for appropriate vascular access planning.
- Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD) due to its lower complication rates compared to central venous catheters (CVCs).
- The impact of early nephrology referral on AVF utilization among ESRD patients initiating HD in Jordan remains understudied.
Purpose of the Study:
- To investigate the rate of early nephrology referral for CKD patients initiating HD in Jordan.
- To assess the impact of prior nephrology care on the type of vascular access used at the initiation of hemodialysis.
- To identify opportunities for improving AVF utilization through enhanced nephrology referral pathways.
Main Methods:
- A cross-sectional study involving patients on in-center HD at a Jordan Ministry of Health dialysis unit.
- Data collection included patient interviews and medical record reviews to determine prior nephrology care and HD access type.
- Statistical analysis compared AVF utilization rates between patients with and without documented prior nephrology care.
Main Results:
- Of 93 eligible patients, only 54% received nephrology care before initiating HD; 48% of those starting with a CVC had prior nephrology care.
- All patients (100%) who initiated HD with an AVF had received prior nephrology care, compared to none of the patients who initiated with a CVC.
- Patients seen by nephrology >1 year before HD initiation were significantly more likely to use an AVF (24%) versus those with no prior nephrology care (0%).
Conclusions:
- A substantial proportion of ESRD patients in Jordan initiate HD without prior nephrology consultation, leading to suboptimal vascular access.
- Early and adequate nephrology referral is strongly associated with the use of AVF at the initiation of hemodialysis.
- Implementing national strategies to improve nephrology referral for advanced CKD patients is crucial for increasing AVF utilization and improving patient outcomes.
Abstract:
Chronic kidney disease (CKD) patients who reach end-stage renal disease (ESRD) require early nephrology referral and appropriate vascular access. Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Referral to nephrology of CKD patients starting HD in Jordan and its impact on AVF utilization is unknown. Patients on in-center HD in a large Jordan Ministry of Health dialysis unit were interviewed, and medical records reviewed to assess prior nephrology care and AVF use. Of 104 total patients, 93 met the inclusion criteria. The mean age was 50 ± 16 years, with 44% being females. The average body mass index was 25 ± 5. The cause of ESRD was diabetes mellitus in 28 (30%), hypertension in 28 (30%), and polycystic kidney disease in three (3%). Type of HD access at the initiation of dialysis was central venous catheter (CVC) in 80 (86%) and AVF in 12 (13%). Of the overall group, 50 (54%) were seen by nephrology before initiating dialysis, and of these, 39 patients (78%) were seen >1 year before HD initiation. Of the patients who initiated dialysis with a CVC, 38 (48%) had received prior nephrology care. All 12 patients who initiated dialysis with AVF had received prior nephrology care. Of the 50 patients who received nephrology care before dialysis initiation, 12 patients (24%) had started dialysis with an AVF; in patients without prior nephrology care, all were started with a CVC. In conclusion, our study suggests that a large percentage did not have nephrology care before initiating dialysis. The ones who were seen by nephrology before dialysis were significantly more likely to initiate dialysis using an AVF. A national focus on improving nephrology referral in advanced CKD may allow better utilization of AVF as the method of access at dialysis initiation.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:15Dialysis
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications