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Kidney Week

Abstract: FR-PO463

Global Variability and Patterns of Use in Vascular and Peritoneal Access for Dialysis: Analysis of the ISN-Global Kidney Health Atlas Data

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Shah, Samveg, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ghimire, Anukul, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ye, Feng, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Tungsanga, Somkanya, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Vachharajani, Tushar J., Wayne State University, Detroit, Michigan, United States
  • Okpechi, Ikechi G., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Levin, Adeera, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Johnson, David W., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Bello, Aminu K., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background

A well-functioning access (vascular or peritoneal) is key to adequate performance of dialysis. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) survey identified gaps in availability, patterns of use, funding models, and workforce for the provision of vascular and peritoneal accesses across countries.

Methods

Using the second iteration of the ISN-GKHA, countries were categorized by affiliations in the ISN regional boards and by World Bank income classification. Questions focused on availability of surgical aspects of care, access to education and availability of providers for the access creation.

Results

Data was available from 159 countries out of 160 that participated in the survey. Overall, public funding was available for hemodialysis (HD) central venous catheters in 92 countries (57%), for HD fistula or graft creation in 86 countries (54%), and for PD catheter surgery in 85 countries (54%). Public funding for the access types was highest in high-income countries than other country income categories. Overall, and in countries where HD was available, >75% of patients initiated HD with a temporary catheter in 21% of countries compared to patients commencing with a tunneled catheter (5%) or a fistula (5%) (Figures 1). Shortages of surgeons and radiologists were highest in low-income and lower-middle income countries.

Conclusion

There is significant variation in the availability, accessibility and patterns of use of vascular access and peritoneal catheters across countries with significant limitations in the needed workforce. In order to improve the outcomes and survival of patients on dialysis, strategies to increase the uptake of viable access are required.