Hamadah Abdurrahman M
Department of Internal Medicine, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
Saudi J Kidney Dis Transpl. 2019 Jul-Aug;30(4):905-912. doi: 10.4103/1319-2442.265467.
Current guidelines recommend arteriovenous fistula (AVF) as the preferred method of access for hemodialysis (HD) patients; however, its utilization remains low. The attitudes of Jordanian HD patients and perceived barriers toward AVF are unknown and have not been well studied. In-center HD patients in the Jordan Ministry of Health largest dialysis unit were interviewed, and a questionnaire was administered inquiring about their experiences, attitudes, and perceived barriers toward AVF. Of 104 total patients, 93 met the inclusion criteria. Mean age was 50 ± 16 years, with 44% being female. Average body mass index was 25 ± 5. The cause of end-stage renal disease was diabetes mellitus in 28 (30%), hypertension in 28 (30%), and polycystic kidney disease in three (3%). Patients had an average time on dialysis of 72 months (range 1-240). Current method of HD access was AVF in 45 (48%) and central venous catheter in 30 (32%). The most reported perceived cause of no AVF was delayed referral to surgical evaluation in 19 (40%), refusal to undergo AVF surgical procedure in 16 (33%), and poor understanding of disease in 13 (27%). Of the total studied group, only 29 (31%) indicated that they received sufficient education/information about AVF prior to creation of HD access. Seventy-eight patients (84%) reported that they would recommend AVF as method of access for other HD patients. The reason why majority of patients preferred AVF was reported as: easier to care for 51 (65%), better associated hygiene 26 (33%), and perceived less infection risk 24 (31%). In conclusion, in this sample population from HD patients in Jordan, majority would recommend an AVF as mode of access. Perceived barriers include lack of timely referral for vascular surgical evaluation and poor understanding of disease. A systematic assessment of the process that precedes the creation of AVF, with focus on areas of reported barriers may allow for better utilization of AVF.
当前指南推荐动静脉内瘘（AVF）作为血液透析（HD）患者的首选血管通路；然而，其使用率仍然较低。约旦HD患者对AVF的态度以及感知到的使用障碍尚不清楚，也未得到充分研究。对约旦卫生部最大透析单位的中心HD患者进行了访谈，并发放了一份问卷，询问他们对AVF的经历、态度和感知到的障碍。在总共104名患者中，93名符合纳入标准。平均年龄为50±16岁，44%为女性。平均体重指数为25±5。终末期肾病的病因是糖尿病28例（30%）、高血压28例（30%）、多囊肾病3例（3%）。患者的平均透析时间为72个月（范围1 - 240个月）。当前的HD血管通路方法为AVF的有45例（48%），中心静脉导管的有30例（32%）。最常被提及的未选择AVF的原因是延迟转诊至外科评估19例（40%）、拒绝接受AVF手术16例（33%）、对疾病了解不足13例（27%）。在整个研究组中，只有29例（31%）表示在建立HD血管通路之前，他们获得了关于AVF的充分教育/信息。78名患者（84%）报告称他们会向其他HD患者推荐AVF作为血管通路方法。大多数患者选择AVF的原因被报告为：护理更容易51例（65%）、卫生状况更好26例（33%）、感染风险更低24例（31%）。总之，在约旦HD患者的这个样本群体中，大多数人会推荐AVF作为血管通路方式。感知到的障碍包括缺乏及时转诊至血管外科评估以及对疾病了解不足。对建立AVF之前的过程进行系统评估，重点关注报告的障碍领域，可能会提高AVF的使用率。
