Practice of dialysis access interventional nephrology procedures in the Asia-Pacific region: Getting lay of the land

Jasuja S 1 , Gallieni M 2 , Jha V 3 , Vachharajani T 4 , Bhalla AK 5 , Tan J 6 Show all authors , Tan CS 7 , Basnet NB 8 , Herath N 9 , Hai An HP 10 , Kim YS 11 , Kim Y 11 , SampathKumar K 12 , Sahay M 13 , Ramachandran R 14 , Alexander S 15 , Bhargava V 5 , Balasubramaniam J 16 , Voss D 17 , Ogbac FE 18 , Gunawan A 19 , Goh BL 20 , Lin CC 21 , Khan J 22 , Shiham I 23 , Ayub H 24 , Hein MA 25 , Iqbal S 26 , Srisawat N 27 , Gao B 28 , Sajiv C 29 , Wilkinson C 30 , Pichthida T 31 , Rana DS 5 , Sagar G 1 , Bahl A 1 , Tawakley S 1 , Gaur M 1

Affiliations 

  • 1 Indraprastha Apollo Hospital, New Delhi, India
  • 2 DIBIC "L. Sacco", Università degli Studi di Milano, Milano, Italy
  • 3 Fortis Kidney and Urology Institute, New Delhi, India
  • 4 John D. Dingell Veterans Affair Medical Center, Detroit, Michigan, USA
  • 5 Sir Ganga Ram Hospital, New Delhi, Delhi, India
  • 6 Rimba Dialysis Center, Simpang, Brunei Darussalam
  • 7 Singapore General Hospital, Singapore, Singapore
  • 8 Nepal Mediciti Hospital, Karyabinayak, Nepal
  • 9 Teaching Hospital, Kurunegala, Sri Lanka
  • 10 Hanoi Medical University, Hanoi, Vietnam
  • 11 College of Medicine, St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
  • 12 Meenakshi Mission Hospital and Research Centre, Madurai, India
  • 13 Osmania General Hospital, Hyderabad, India
  • 14 PGIMER, Chandigarh, India
  • 15 Christian Medical College (CMC), Vellore, India
  • 16 Kidney Care Centre, Tirunelveli, Tamil Nadu, India
  • 17 Middlemore Hospital, Auckland, New Zealand
  • 18 University of Brawijaya, Malang, Indonesia
  • 19 St Luke's Medical Center, Quezon City, Philippines
  • 20 Hospital Serdang, Kajang, Malaysia
  • 21 Taipei Veterans General Hospital, Taipei, Taiwan
  • 22 Jamhuriat Teaching Hospital, Kabul, Afghanistan
  • 23 Indira Gandhi Memorial Hospital, Male, Maldives
  • 24 Hameed Latif Hospital, Lahore, Pakistan
  • 25 Defence Services Medical Academy (DSMA), Yangon, Myanmar
  • 26 BIRDEM General Hospital, Dhaka, Bangladesh
  • 27 Chulalongkorn University, Bangkok, Thailand
  • 28 Affiliated Zhongshan Hospital of Dalian University, Dalian, China
  • 29 Alice Springs Hospital, The Gap, Northern Territory, Australia
  • 30 Cairns and Hinterland Hospital and Health Service, Cairns North, Queensland, Australia
  • 31 School of Medicine, International University, Phnom Penh, Cambodia
Nephrology (Carlton), 2023 Dec;28(12):672-681.
PMID: 37697492 DOI: 10.1111/nep.14236

Abstract

AIM: This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA).

METHODS: The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey.

RESULTS: Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel.

CONCLUSION: The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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