TITILE: Causes of the delay in creating permanent vascular access in hemodialysis patients.

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.

SOURCE: Alfarhan MA, Almatrafi SA, Alqaseer SM, et al. Causes of the delay in creating permanent vascular access in hemodialysis patients[J]. Saudi J Kidney Dis Transpl, 2020, 31(6):1217-1224. DOI: 10.4103/1319-2442.308330. 

摘要：大多数慢性肾脏病(CKD)患者使用中心静脉导管进行血液透析(HD)，但存在多种并发症。本研究旨在了解医生对沙特阿拉伯王国延迟建立动静脉内瘘(AVF)原因的看法，以提高CKD患者的护理质量和预后，预防并发症。对KSA肾病学家进行了一项横断面描述性研究，调查问卷包括与AVF产生延迟相关的因素，分为患者因素、医生因素和医院因素。同时对开始透析的最佳时机进行了评估。在212名参与者中，131名(61.8%)是顾问级别的，其中来自中部地区的人数最多(52.4%)。与AVF建立延迟相关的最重要的患者因素是否认肾脏疾病或需要AVF(76.4%)，透析恐惧和实际担心(75.9%)，以及患者拒绝(73.1%)。最重要的医生和医院因素是透析前护理和教育进行得不充分(63.7%)和较晚转诊到肾科医生(56.6%)。当患者达到CKD-4期(69.3%)或5期(27.4%)时，参与者会建立动静脉内瘘，88.7%的参与者会在预期的HD开始前3-6个月这样做。超过三分之二(68.4%)的参与者选择患者作为导致永久性血管通路延迟的主要因素。需要一种有效的方法来选择患者，以患者为中心的透析前护理，并转诊到可应用于不同地区不同类型患者的血管通路创建。

启发：让患者接受将来需长期透析的观念的确有点困难，特别还没进入透析状态。但是作为临床工作者，需加强患者教育与沟通，接受这一事实，并配合提前建立动静脉内瘘（6个月）。还有一个问题是，如何确认这6个月时间，也是我们要努力探索的。