Abdul Latif1, Shubharthi Kar2, Abu Ahmed Golam Akbar3,
Minhaz Nizam Uddin4, Rajendra Prasad Das5
1. Associate Professor & Head, Department of Nephrology, Jalalabad Ragib-Rabeya Medical College, Sylhet, Bangladesh.
2. Associate Professor of Nephrology, Sheikh Hasina Medical College, Habiganj, Bangladesh.
3. Medical Officer, Department of Nephrology, Sylhet M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh.
4. Medical Officer, Department of Nephrology, Jalalabad Ragib-Rabeya Medical College, Sylhet, Bangladesh.
5. Medical Officer, Department of Nephrology, Jalalabad Ragib-Rabeya Medical College, Sylhet, Bangladesh.
Abstract
Chronic Kidney Disease (CKD) is the most prevalent renal disease worldwide which often leads to ESRD (End Stage Renal Disease) dependence on RRT. Hemodialysis continues to be the single most prevalent modality of renal replacement therapy in the United States as well as worldwide. A well functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis. AVF (Arteriovenous Fistula) is the best vascular access for longevity, lowest association with morbidity and mortality and remains the first choice for MHD. Frequent use of catheters like JVC (Jugular Vein Catheter) or FVC (Femoral Vein Catheter) is inefficient vascular access with higher complication rate with higher morbidity and mortality in ESRD patients, whereas AVF though unpopular in our country is a sustainable solution. This observational cross-sectional study conducted in multiple dialysis centers in the northwestern region of Sylhet division attempted to observe the current use of AVF as first vascular access, find out the obstacles to create AVF and how to increase its use. Out of 320 patients 59% were male and 41% were female, mean age was 50 years. FVC was found to be most frequently used VA (63.4%) followed by JVC (25.9%) which add up to 89,3% of all catheters, AVF only comprised of a tiny share (9.4%) with Tunneled cuff catheter (1.3%). Initially patient’s reluctance towards dialysis, financial crisis and vascular problem sum up to 53% of all the causes with 83 (25.9%), 42 (13.1%) & 45 (14.1%) patients respectively. The other half include, lack of time to create AVF before initiate dialysis 36 (11.3%), lack of doctor’s advice 28 (8.8%), cardiac problem 22 (6.9%), inability to understand need of long term HD 36 (11.3%) where as it was evident that AVF is beneficial as per opinion of (85.9%) patients after creating AVF followed by initial dialysis catheters. Therefore, use of AVF is proven to be better for patients in our country and is already accepted globally, rising frequency of AVF as initial VA in dialysis is a matter of practice.
Key Words: Fistula, Arterio-venous Fistula (AVF), First Fistula, Dialysis, Chronic Kidney Disease (CKD), End-stage Renal Disease (ESRD)