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Causes of the delay in creating permanent vascular access in hemodialysis patients
Maha A Alfarhan1, Shahad A Almatrafi1, Sumaia M Alqaseer2
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Insights
Physicians identified patient denial, fears, and refusal as primary reasons for delayed arteriovenous fistula (AVF) creation in chronic kidney disease (CKD) patients. Improving predialysis education and timely referrals are crucial for better patient outcomes.
Area of Science:
- Nephrology
- Vascular Access Surgery
- Public Health
Background:
- Chronic kidney disease (CKD) management often involves hemodialysis (HD), frequently accessed via central venous catheters (CVCs).
- CVCs are associated with significant complications, highlighting the need for timely arteriovenous fistula (AVF) creation as preferred vascular access.
- Understanding physician perspectives on delayed AVF creation is essential for improving CKD patient care in Saudi Arabia.
Purpose of the Study:
- To investigate nephrologists' perspectives on the factors contributing to delayed AVF creation in the Kingdom of Saudi Arabia (KSA).
- To identify patient, physician, and hospital-related reasons for the delay in establishing permanent vascular access for hemodialysis.
- To inform strategies for optimizing AVF creation timing and preventing associated complications.
Main Methods:
- A cross-sectional descriptive study was conducted among nephrologists in KSA.
- A questionnaire was utilized to gather data on perceived reasons for AVF creation delays.
- Factors were categorized into patient, physician, and hospital domains, with assessment of optimal dialysis initiation timing.
Main Results:
- Patient-related factors, including denial of disease (76.4%), dialysis fears (75.9%), and refusal (73.1%), were cited as major contributors to delayed AVF creation.
- Insufficient predialysis education (63.7%) and late nephrology referral (56.6%) were identified as key physician and hospital factors.
- Most participants recommended AVF creation at Stage 4 (69.3%) or Stage 5 (27.4%) CKD, ideally 3-6 months before anticipated HD initiation.
Conclusions:
- Patient-related issues are perceived as the predominant cause for delayed permanent vascular access, accounting for over two-thirds of delays.
- There is a need for a standardized approach encompassing patient selection, patient-centered predialysis care, and timely referral for vascular access procedures.
- Addressing these factors can enhance the quality of care and prognosis for CKD patients requiring hemodialysis.
Abstract:
Majority of the chronic kidney disease (CKD) patients undergo hemodialysis (HD) with central venous catheter which has multiple complications. This study aims to identify the physicians' perspectives regarding the reasons of delayed arteriovenous fistula (AVF) creation in the Kingdom of Saudi Arabia to improve the quality of CKD patients' care and prognosis and prevent complications. A cross-sectional descriptive study was conducted on KSA nephrologists using a questionnaire which includes factors associated with delay in AVF creation, which were categorized into patient, physician, and hospital factors. The optimal timing of starting dialysis was also assessed. In a total of 212 participants, 131 (61.8%) were of consultant level, with the largest numbers being from the Central region (52.4%). The most important patient factors associated with delay in AVF creation were denial of kidney disease or the need of AVF (76.4%), dialysis fears and practical concern (75.9%), and patient refusal (73.1%). The most important physician and hospital factors were insufficient conduction of predialysis care and education (63.7%) and late referral to a nephrologist (56.6%). Participants would create AVF when the patient reaches Stage 4 CKD (69.3%) or Stage 5 (27.4%), and 88.7% of the participants would do so 3-6 months before the anticipated start of HD. Over two-thirds of the participants (68.4%) chose patient as the main factor contributing to the delay of permanent vascular access. A validated approach to patient selection, patient-centered predialysis care, and referral to vascular access creation that could be applied on different types of patients in different regions is required.
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