Global variability of vascular and peritoneal access for chronic dialysis.
A global survey of 167 countries documented substantial variation in the availability, funding, workforce, and use of vascular and peritoneal dialysis access, with the largest gaps concentrated in low-income countries.
Background
Vascular and peritoneal access are essential for sustaining chronic dialysis programs, yet contemporary global data on their availability, patterns of use, funding models, and workforce have been limited. This study used an electronic survey of national nephrology society leaders, consumer organizations, and policymakers conducted from July to September 2018.
Study design
Data were available from 167 countries, with questions focused on the types of access used to initiate dialysis, funding for these services, and the availability of providers for access creation. Countries were compared across World Bank income classifications to characterize disparities.
Key findings
In 25% of surveyed countries, more than 75% of patients initiated hemodialysis with a temporary catheter, while only 5% of countries had more than 75% starting with an arteriovenous fistula or graft. Reliance on temporary catheters was far higher in low-income countries (57%) than in high-income countries (5%). Shortages of surgeons to create vascular access were reported in 91% of low-income countries versus 46% of high-income countries, and roughly 95% of low-income countries reported shortages of surgeons for peritoneal dialysis access compared with 26% of high-income countries. Public funding for access procedures was available in just over half of countries.
Clinical implications
The findings reveal major inequities in dialysis access infrastructure, with low-income countries disproportionately dependent on temporary catheters and private out-of-pocket funding. Addressing these gaps will require investment in surgical workforce, funding mechanisms, and access-creation capacity to improve dialysis outcomes globally.
Category
Research
Source
Nephrology (Carlton)
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.