A new study from the University of Limerick has found that the treatment used for the majority of kidney failure patients in Ireland can lead to increased rates of hospitalization, infection and even death.
A study carried out by a team from the University of Limerick's Faculty of Medicine found a high rate of central venous catheter dependence in Irish patients undergoing hemodialysis, which researchers believe is worse than in patients in other countries. We believe that this may lead to clinical outcomes.
Patients who develop kidney failure rely heavily on the “lifeline” connection between the dialysis machine and the patient's blood vessels. This connection is usually in the form of an arteriovenous fistula (AVF), which is a surgical connection between a vein and an artery within a patient's blood vessels, or a large central venous catheter (CVC), which is an artificial plastic tube inserted into a large vein. It will be. Inside the body (usually the veins in the neck).
New national study by UL researchers, Published in Kidney360 magazinefound that AVF placement rates among dialysis patients were extremely low and CVC utilization rates were correspondingly high, which may lead to higher patient hospitalization and mortality rates.
The study found that Irish patients who started dialysis were more likely to use a catheter than a fistula for treatment (77% vs. 23%), and the proportion of patients with a functioning fistula was lower at the main Irish center. It was shown that there was a large difference between The proportion of patients with fistulae increased only slightly at the end of the first year of dialysis.
International studies have demonstrated that countries with fistula rather than catheter policies have better clinical outcomes for patients than those without.
“Using catheters for hemodialysis increases patient infection rates and increases the risk of clotting problems, hospitalization and even death,” said Dr. Roberts, Foundation Medical Director of UL Medicine and Consultant Nephrologist at University Hospital Limerick. Professor Austin Stack explains: Senior author of the study.
“As a result, national clinical programs and professional societies recommend the use of fistulas over catheters for most patients starting hemodialysis.
“The results of this new national study highlight that Ireland lags behind international best practice in achieving fistula rates in hemodialysis patients.
“The low rates of fistula use and high rates of catheter dependence at the start of dialysis are very worrying and need to be addressed at a national level, as they can lead to higher patient infection and hospitalization rates. ' Professor Stack added.
The study, funded by the Health Research Board (HRB), looked at 610 patients who started hemodialysis in Ireland between 1 January 2015 and 31 December 2016 and were followed up one year later. Ta.
The researchers noted that only 33% of patients were using a fistula three months after starting dialysis, and the remaining 77% were catheter-dependent. These results are well below international standards where other countries report much higher rates of fistula use at the start of dialysis (56% in Germany and 53% in the UK).
The researchers also found that there was wide variation in the proportion of patients using a fistula across major dialysis centers in Ireland, ranging from as low as 9% in one center to 37% in another. I also noticed that. These variations in prevalence were not explained by differences in patient age or general clinical health status. According to the research team, this suggests that non-patient-related factors are responsible for the extremely low uptake of AVFs in the Irish healthcare system.
At the end of the 1-year follow-up, the proportion of patients with functioning fistulas had increased only slightly to 41%, with the remainder using artificial catheters for dialysis. Again, there remains significant variation in the proportion of fistulas and catheters in use across dialysis facilities in Ireland.
Lead author Dr Wael Hussein said the study highlighted the need for a detailed investigation into why the incidence of fistulas in Ireland is so low compared to other European countries.
“Our analysis suggests that factors related to the organization and planning of vascular access in individual centers, factors that take place outside the patient area, are responsible for the poor outcomes observed. ” he explained.
“These factors include resourcing the current national hemodialysis program with access to dedicated vascular surgical support and theater time, recruiting vascular nursing experts similar to international centers of excellence, and improving vascular access pathways and quality. This may include high-level coordination to ensure high indicators and “timely implementation,'' Dr. Hussain added.
With over 500 new patients developing kidney failure and requiring dialysis each year in Ireland and over 2,000 patients a year being treated on hemodialysis programmes, Professor Stack said: Programs need to be resourced and empowered to respond to our needs.” patient”.
Dr Máiréad O'Driscoll, CEO of the Health Research Council, added: “We aim to improve people's health, improve patient care and support research that saves lives. This study does just that, and will help patients in Ireland receive hemodialysis. We wish Professor Stack and his team continued success in their research.”
