College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2020 Nov-Dec;31(6):1217-1224. doi: 10.4103/1319-2442.308330.
Majority of the chronic kidney disease (CKD) patients undergo hemodialysis (HD) with central venous catheter which has multiple complications. This study aims to identify the physicians' perspectives regarding the reasons of delayed arteriovenous fistula (AVF) creation in the Kingdom of Saudi Arabia to improve the quality of CKD patients' care and prognosis and prevent complications. A cross-sectional descriptive study was conducted on KSA nephrologists using a questionnaire which includes factors associated with delay in AVF creation, which were categorized into patient, physician, and hospital factors. The optimal timing of starting dialysis was also assessed. In a total of 212 participants, 131 (61.8%) were of consultant level, with the largest numbers being from the Central region (52.4%). The most important patient factors associated with delay in AVF creation were denial of kidney disease or the need of AVF (76.4%), dialysis fears and practical concern (75.9%), and patient refusal (73.1%). The most important physician and hospital factors were insufficient conduction of predialysis care and education (63.7%) and late referral to a nephrologist (56.6%). Participants would create AVF when the patient reaches Stage 4 CKD (69.3%) or Stage 5 (27.4%), and 88.7% of the participants would do so 3-6 months before the anticipated start of HD. Over two-thirds of the participants (68.4%) chose patient as the main factor contributing to the delay of permanent vascular access. A validated approach to patient selection, patient-centered predialysis care, and referral to vascular access creation that could be applied on different types of patients in different regions is required.
大多数慢性肾脏病（CKD）患者需要接受中心静脉导管的血液透析（HD）治疗，这会带来多种并发症。本研究旨在确定沙特阿拉伯医生对延迟动静脉瘘（AVF）创建的原因的看法，以改善 CKD 患者的护理和预后质量，并预防并发症。采用问卷调查对沙特阿拉伯肾脏病医生进行了横断面描述性研究，问卷包括与 AVF 创建延迟相关的因素，这些因素分为患者、医生和医院因素。还评估了开始透析的最佳时机。在总共 212 名参与者中，有 131 名（61.8%）为顾问级别，其中来自中央地区的人数最多（52.4%）。与延迟 AVF 创建相关的最重要的患者因素包括否认肾病或需要 AVF（76.4%）、对透析的恐惧和实际顾虑（75.9%）以及患者拒绝（73.1%）。最重要的医生和医院因素是预透析护理和教育不足（63.7%）以及延迟转介给肾病医生（56.6%）。参与者将在患者达到 CKD 第 4 期（69.3%）或第 5 期（27.4%）时创建 AVF，88.7%的参与者将在预计开始 HD 的 3-6 个月前创建 AVF。超过三分之二的参与者（68.4%）选择患者是导致永久性血管通路延迟的主要因素。需要一种经过验证的患者选择方法、以患者为中心的预透析护理以及转介到血管通路创建，该方法可以应用于不同地区的不同类型患者。
