Patterns of vascular access among chronic kidney disease patients on maintenance hemodialysis at Muhimbili National Hospital. A single centre cross-sectional study

Abstract

Background: Hemodialysis access profoundly impacts the quality of care for chronic kidney disease (CKD) patients worldwide, with arteriovenous fistulas (AVFs) preferred for superior outcomes. Despite global guidelines, Sub-Saharan Africa, including Tanzania, faces challenges, as it relies heavily on nontunneled central venous catheters (CVCs) due to accessibility and financial constraints. We aimed to describe the pattern of vascular access use among CKD patients on maintenance hemodialysis at Muhimbili National Hospital. Methods: A cross-sectional study to describe the pattern of vascular access among patients with CKD on maintenance hemodialysis therapy. Descriptive statistics were used to summarize the baseline characteristics and patterns of vascular access. Results: We analysed 200 study participants, with a mean age of 53.3 (14.5) years. Almost all participants initiated hemodialysis with nontunneled central venous catheters (95.5%). A substantial portion continued to use nontunneled CVCs (25.5%), with some transitioning to tunneled CVCs (39.5%) or AVFs (35%). The mean (SD) duration to use nontunneled CVCs before transitioning to tunneled or AVF were 7.1 (2.1) months. Among patients with multiple nontunneled catheters, catheter dislodgement was the main indication for catheter replacement. Conclusion: Our study highlights the prevalent use of nontunneled central venous catheters (CVCs) as the primary vascular access method for CKD patients undergoing hemodialysis at Muhimbili National Hospital, Tanzania. These findings underscore the urgent need for analysis of the cost associated with nontunneled catheter reliance and interventions to improve access to AVFs and enhance vascular access management, ultimately optimizing patient outcomes in resource-limited settings.