Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia

Raja Ramachandran, Vinant Bhargava, Sanjiv Jasuja*, Maurizio Gallieni, Vivekanand Jha, Manisha Sahay, Suceena Alexender, Mamun Mostafi, Jayakrishnan K. Pisharam, Tang Sydeny Chi Wai, Chakko Jacob, Atma Gunawan, Goh Bak Leong, Khin Thida Thwin, Rajendra Kumar Agrawal, Kriengsak Vareesangthip, Roberto Tanchanco, Lina Choong, Chula Herath, Chih Ching LinNguyen The Cuong, Syed Fazal Akhtar, Ali Alsahow, D. S. Rana, Vijay Kher, M. M. Rajapurkar, L. Jeyaseelan, Sonika Puri, Gaurav Sagar, Anupam Bahl, Shalini Verma, Anil Sethi, Tushar Vachharajani

*Corresponding author for this work

Research output: Contribution to journalEditorial

6 Scopus citations

Abstract

South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.

Original languageEnglish
Article number11297298211011375
Pages (from-to)849-860
Number of pages12
JournalJournal of Vascular Access
Volume23
Issue number6
DOIs
StateE-pub ahead of print - May 2021

Keywords

  • AV fistula
  • Southeast Asia
  • Vascular access
  • interventional nephrology (IN)
  • tunneled catheter
  • vascular access surveillance

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