1. Vivekanand Jha, Rajasekara Chakravarthi, Kamal D. Shah
Vascular access in dialysis patients: Observations from a national dialysis cohort in India
Vivekanand Jha, Rajasekara Chakravarthi, Kamal D. Shah

2. Introduction EBPG on vascular access
1.2. Every CRF patient should start with functioning vascular access
1.3. Potential chronic patients should be referred for vascular access at eGFR < 30 ml/min
Aim: minimization of use of catheters, with related morbidity and hospitalizations
Native AVF considered the gold standard for vascular access
Several initiatives have promoted an early construction of AVF in HD patients

3. Gallieni et al, Seminars Interven Radiol 2012

4. Introduction HD is growing rapidly in India
Vascular access an important limiting factor for patient outcomes
The pattern of vascular access in chronic HD patients in India is not known

5. To describe the vascular access use in a large pan-India HD cohort
Aim of the study
To describe the vascular access use in a large pan-India HD cohort

6. Methodology Multicentric retrospective observational study
Study setting: NephroPlus dialysis centers (n=31)
Patients who started dialysis from Jan 2013 to Dec 2014
Nature of vascular access at the time of joining the program noted
Access related events monitored

7. Location of NephroPlus HD centers

8. Results Number of subjects: 1,688 Age: 52.2 ± 14.1 (15­82) yrs
Sex ratio: :3.1
Cause of kidney disease:
Hypertensive Nephrosclerosis 46%
Diabetic Nephropathy 35%.
Others %
Time since diagnosis of ESRD: ± 18.7 (0-198) mo
Dialysis start:
de novo: 21%
transfer from other facilities: 79%

9. Vascular access at the time of entry
No of cases
Percent
AVF
1054 62
Non-tunnelled dialysis catheter
555 33
Tunnelled dialysis catheter 42 3
AV Shunt 19 1
AV Graft 18
Total
1688
100

10. Access pattern according to centers where HD was initiated
AVF
Catheter
Those who started HD elsewhere
64%
35%
Those who started HD in NephroPlus facility
59%
38%

11. Access type in incident patients over time

12. Access pattern in different centers Jan 2013

13. Access pattern in different centers Dec 2014

14. Association between reimbursement type and time to creation of AVF
Type of reimbursement
Mean no. of days
Pvt. Insurance
46 ± 43 (4­277)
Govt. Sponsored
51 ± 42 (4­269)
Self-paying
58 ± 50 (5­305)
All
58 ± 49 (4­305)

15. Follow up
Follow up period: ± 18.5 (range 1­24) mo (14,844 patient months)
A total of 64 interventions needed in 54 patients
Dropouts
Patients continuing on HD
Dropouts
AVF at start
67.2%
32.8%
No AVF at start
63.6%
36.4%

16. Conclusions
First study to describe the pattern of vascular access in India
A high proportion of incident patients had AVF, and AVF use improved over study period
Possible to achieve uniformity across centers with appropriate access planning
Limitations
Selected patient population
Large proportion had been initiated on HD elsewhere before entry in NephroPlus center
Details of factors influencing access choice not available