Changing pattern of vascular access use for maintenance haemodialysis in a tertiary hospital in Southern Nigeria

Abstract

Background: Patients who choose haemodialysis (HD) as a mode of renal replacement therapy require vascular access before initiation of dialysis. The options include a native arteriovenous fistula (AVF), a synthetic graft, and a central venous catheter. Maintaining a well functioning vascular access continues to be one of the greatest challenges in maintenance HD.

Methods: A retrospective analysis of dialysis records and case notes of prevalent HD patients over a six-year period, between July 2009 and September 2014 at the University of Benin Teaching Hospital, Benin City, Nigeria.

Results: A total of 591 patients with ESRD underwent dialysis during the period; male: female ratio of 1.2:1. Predominant age group with ESRD was 30-39 years (30%) and hypertension was the commonest aetiology of ESRD. All patients (100%) commenced HD with femoral catheters in 2009 while 5 (0.8%) commenced with AVF between 2011 and 2014. Only 43 (7.3%) had functional permanent vascular access. There was a progressive increase in the number of patients using (functional) AVF for HD from 2.2% in 2011, 8.5% in 2013 to 9.8% in 2014; with a reduction in the number of patients using femoral catheters from 51.5% in 2011, 41% in 2013 to 32.5% in
2014. Majority of patients (38%) were on tunneled catheters in the 6th year of review (2014).

Conclusion: There is a rising trend towards the use of permanent vascular access among our HD population and a decreasing trend in the use of femoral catheters for HD. Compared with other types of vascular access, there were more patients on tunneled catheters in the 6th year of review (2014).