| Autor: |
Ramachandran R; PGIMER, Chandigarh, India., Bhargava V; Sir Ganga Ram Hospital, India., Jasuja S; Indraprastha Apollo Hospital, India., Gallieni M; University of Milano, Italy., Jha V; Executive Director, George Institute of Global Health, India., Sahay M; Osmania General Hospital, India., Alexender S; CMC, India., Mostafi M; Department of Nephrology, Armed Forces Medical College, Bangladesh., Pisharam JK; Ministry of Health, Brunei, Darussalam Medical Services, Brunei., Chi Wai TS; Department of Nephrology, Queen Mary Hospital, Hong Kong., Jacob C; Bangalore Baptist Hospital, India., Gunawan A; Brawijaya University, Indonesia., Leong GB; Serdang Hospital, Malaysia., Thwin KT; University Of Medicine, Myanmar., Agrawal RK; Department of Nephrology, Bir Hospital, Nepal., Vareesangthip K; Nephrology Society of Thailand, Thailand., Tanchanco R; The Medical City, Philippine., Choong L; Singapore General Hospital, Singapore., Herath C; Singapore General Hospital, Singapore., Lin CC; Taipei Veterans General Hospital., Cuong NT; Department of Kidney diseases and Dialysis, Viet Duc University Hospital, Vietnam., Akhtar SF; Sindh Institute of Urology and Transplantation, Pakistan., Alsahow A; Jahara Hospital, Kuwait., Rana DS; Sir Gangaram Hospital, India., Kher V; Medanta Hospital Gurugram, India., Rajapurkar MM; Muljibhai Patel Urological Hospital, India., Jeyaseelan L; CMC, India., Puri S; Rutgers Robert Wood Johnson Medical School, USA., Sagar G; Indraprastha Apollo Hospital, India., Bahl A; Indraprastha Apollo Hospital, India., Verma S; AVATAR foundation, India., Sethi A; AVATAR foundation, India., Vachharajani T; Cleveland Clinic, USA. |
| Abstrakt: |
South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries. |
