Comparative Analysis Of Vascular Access For Haemodialysis In End-Stage Renal Disease In A Developing And Developed Country.

摘要

Background: End Stage Renal disease (ESRD) is an important and growing medical problem all over the world especially in developing countries. Securing adequate vascular access is an essential part of managing affected patients. Objectives: To compare vascular access routes for haemodialysis in a developed and developing country setting.Method: Case notes were studied for information on age, gender, vascular access routes at University of Nigeria teaching hospital (UNTH) from January to July 2000. Operation lists and case notes used at Texas Heart Institute (THI) from October 2005 to March 2006 were reviewed to provide the above information. The findings were compared. Result: One hundred and fifty nine and Ninety four patients at THI and UNTH respectively were studied. There was similar gender pattern among patients seen at both institutions. The mean age in years of patients with ESRD requiring haemodialysis was lower at UNTH (44.6±17.1 as against 56.2±14.8 in THI), p<0.001. Direct femoral vein cannulation was the main vascular access route in UNTH (93.6%), whereas left hand arteriovenous graft (AVG) was the commonest route at THI (34.6%). Conclusion: We conclude that the prevalent vascular routes differ in these two centers with THI having a well established renal replacement protocol. The important challenges at UNTH include inadequate manpower, general poverty of the patients, lack of vascular access creation materials and unavailability of organized health policy for patients with ESRD in Nigeria. These problems are common in most developing countries. This paper was presented at the 51 st Annual General Meeting and Scientific Conference of West African College of Surgeons, Dakar Senegal on July 3, 2011. Introduction End Stage Renal Disease (ESRD) is a significant and growing medical problem in the United States of America1 and indeed all over the world, especially in the developing countries such as Nigeria2. Securing vascular access is an essential part of any haemodialysis (HD) programme. In December 31, 1999, the point prevalence of patients with ESRD receiving HD was 209,637 and this number increased by approximately 4.2% per year between 1995 and 19993. The first arteriovenous fistula (AVF) constructed for haemodialysis access was created by Kenneth Apple in February 1965 at the Bronx Veterans Administration Hospital in collaboration with James Cimino, and Nephrologists Michael Brescia and Baruch Hurwich4. Before this, dialysis access was possible only by direct needle cannulation of large vessels or by a Scribner external vascular shunt.End stage renal failure patients requiring long term haemodialysis need a durable vascular access. Various types are available. This study compares what obtains in a typical Nigerian setting, a resource challenged environment with that of an institution in the United States of America. Methods This study was a comparative retrospective one examining the route of vascular access for chronic haemodialysis in the University of Nigeria Teaching Hospital (UNTH), Enugu and Texas Heart Institute (THI), Houston, USA. One of the authors was on a one year clinical cardiovascular surgery fellowship at the THI. This offered the opportunity to obtain data from THI. From UNTH relevant information which included age, gender, vascular access type and vessels used were obtained from the case notes of the patients involved in the study. The period studied at THI was from October 2005 to March 2006, while at UNTH, January to July 2000. Acute cases that required emergency dialysis through any available access route were not included in this study. THI was using cannulation of left subclavian, right internal jugular or femoral vein as the case may be for these cases.Data analysis was done using the statistical package for social sciences (SPSS) version 17.0. Comparison of proportions was done using the chi-square test(x2). Continuous variables were compared using the Analysis of Variance (ANOVA). P valu