Current State of Vascular Access in Patients on Hemodialysis in Bahrain

Background & Objective: Patients on hemodialysis (HD) require well-functioning vascular access for its initiation and successful transition to dialysis. Arteriovenous fistula is recognized internationally as the first choice of vascular access due to its long lifespan and low incidence of complications in comparison to other methods. Despite this, the rates remain poor. The aim of the study was to document the trend of vascular access currently observed in the hemodialysis centers. Methodology: This is cross-sectional study in Hemodialysis Centers in Ministry of Health, Kingdom of Bahrain. All patients undergoing regular hemodialysis in May 2020 were included in this study. Results: A total of 536 patients undergoing regular renal replacement therapy were recruited. Majority of the patients; 478 (89.2%) were on hemodialysis. Of them, 214 (44.8%) patients were on arteriovenous fistula/graft (AVF/ AVG), while the remaining 264 (55.2%) were on tunnel line. Causes of tunnel line hemodialysis were further evaluated. About 137(51.9%) patients were undergoing investigations. This was followed by patient refusal and unfit for surgery among thirty-five (13.3%) and 23 (8.7%) patients, respectively. The remaining patients were either awaiting surgery, or experienced complications post arteriovenous fistula/graft creation. Conclusion: In this study, a high use of tunnel line vascular access in HD was observed in comparison to AVF. A potential for higher utilization of AVF/AVG up to 60% was observed in this practice. Further studies and strategies to increase the usage of AVF is highly recommended to reach international standards and improve patient care.