Dialysis access pattern in incident haemodialysis patients at B & B Hospital, Kathmandu, Nepal.

The clinical practice guideline for vascular access in haemodialysis recommends the use of arteriovenous fistula (AVF) over a central venous catheter. AVF needs to be created sufficiently in advance of anticipated haemodialysis. However, many incident haemodialysis patients are still being dialyzed with central venous catheter at the time of first haemodialysis. This paper aims at presenting the pattern of dialysis vascular access in incident haemodialysis patients at our institution from July 2002 to July 2008 in a cohort of patients who were referred to us for creation of native AVF. A total of 100 patients (56 male and 44 female) with the mean age of 54 years were studied. Only 110.0% of patients were found to have AVF created in advance and the rest (89.0%) were dialyzed via central venous catheter. Of the 11 patients with AVF; 5 fistulas were created 3 months prior to the dialysis, 3 fistulas between 1 and 3 months prior and 3 less than a month of anticipated dialysis. Interestingly, 35.0% of total patients were seen by nephrologists only a month prior to the dialysis. Hence, an early referral of the chronic renal failure patients to the nephrologists and vascular access surgeons may overcome this problem.