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

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.

SOURCE: Ramachandran R, Bhargava V, Jasuja S, et al. Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia[J]. J Vasc Access, 2021 :11297298211011375. DOI: 10.1177/11297298211011375. 

摘要：南亚和东南亚是世界上人口最多，种族最丰富的部分。印度血管通路和介入肾脏协会（AVATAR基金会）收集了该地区流行病学和介入性肾脏病（IN）的趋势。这些国家分为中上收入国家和高收入国家，作为第1组；中下收入国家和中低收入国家，作为第2组。在第1组和第2组国家中，有43％和70％的患者进行了计划外的血液透析（HD）启动。在发生的HD患者中，占优势的血管通路（VA）是第2组的70％的非隧道中央导管（non-TCC）和第1组国家的32.5％的隧道式中心导管（TCC）。在第2组和第1组中，分别有24.5％和35％的HD患者建立了动静脉内瘘（AVF）。2组和1组中分别有8％和68.7％的紧急HD患者通过AVF接受了HD。在第2组和第1组中，进行任何IN程序的肾脏科医生分别为90％和60％。肾脏科医师执行的常见程序包括肾活检（93.3％），腹膜透析（PD）导管插入（80％），TCC（66.7％）和非TCC（100％）。 IN的限制因素包括缺乏时间（73.3％），缺乏后备（40％），缺乏培训（73.3％），经济问题（33.3％），法医学问题（46.6％），无诱因（20 ％），其他利益（46.6％）和机构不支持（26％）。第2组和第1组的常规VA随访分别为12.5％和83.3％。总而言之，非TCC和TCC分别是第2组和第1组HD患者的最常见血管通路。缺乏培训，后备支持和经济限制是第二组国家IN增长的主要限制。

启发：经济决定了整体架构，政策指标制定的时候，需要考虑地区经济的因素。