Role of Experience in Developing an Interventional Nephrology Program at an Academic Center in Pakistan

Abstract

Background: A well-functioning vascular access is the backbone of renal replacement therapy in chronic kidney disease (CKD). Vascular access management is largely done by vascular surgeons and interventional radiologists who are often unaware of its impact and repercussions in the care of dialysis patients. This has led to delayed dialysis, temporary vascular access, hospitalization, and other associated morbidities. Interventional nephrology is a subspecialty of nephrology that increases the involvement of nephrologists in vascular access procedures. The advent of interventional nephrology as a field has not only improved continuity of care but has also led to uninterrupted dialysis treatments and decreased rate of hospitalization. Methods: We established a new interventional nephrology service at the Aga Khan University Hospital, Karachi, Pakistan with the help of an interventional nephrologist accredited by the American Society of Diagnostic and interventional nephrology (ASDIN). The study aims to an arrangement of equipment, and training of staff to assist in procedures. Results: To date, we have placed 20 tunneled dialysis catheters (TDCs), performed 8 arteriovenous fistula (AVF) venoplasty procedures, some venous mapping procedures as well as renal biopsies all in an outpatient setting with good outcomes. We further plan on starting a peritoneal dialysis catheter placement program at our center soon. Conclusion: In a country like Pakistan where resources are limited, interventional nephrology can provide good vascular access care and timely interventions for vascular access dysfunction while allowing the procedures to take place in an outpatient setting, hence minimizing costs. The current study program may be a guide to help establish a similar program by other specialties with the support of the hospital administration. Keywords: Interventional nephrology; Vascular access; Chronic kidney disease; End-stage renal disease; Dialysis