Emergency vascular access conversion to native arterio veinous fistula: a prospective study of 37 hemodialysis patients in Rwanda

• Published in: Néphrologie & thérapeutique Vol. 10; no. 6; pp. 457 - 462
• Main Authors: Kolb, Isabelle, Twagirumugabe, Théogène, Uyisabye, Innocent, Muhizi, Jérôme, Braun-Parvez, Laura, Richter, Sarah, Ntarindwa, Joseph, Nzambaza, Jean-de-Dieu, Rwandenzi, Richard, Kibuka, Martine, Mantz, Françoise
• Format: Journal Article
• Language: French
• Published: France 01-11-2014
• Subjects: Adult; Ambulatory Care; Anesthesia, Local; Arm - blood supply; Arteriovenous Shunt, Surgical; Catheter-Related Infections - etiology; Comorbidity; Emergencies; Female; Humans; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - therapy; Male; Middle Aged; Patient Selection; Peritoneal Dialysis; Prospective Studies; Renal Dialysis; Rwanda; Treatment Outcome; Vascular Access Devices - adverse effects; Fistule artério-veineuse; Arterioveinous fistula; Afrique sub-saharienne; Hemodialysis; Insuffisance rénale chronique; Africa; Rwanda; Catheter; Cathéter; Chronic kidney disease; Hémodialyse
• ISSN: 1872-9177
• DOI: 10.1016/j.nephro.2014.05.005

Chronic hemodialysis in Rwanda is relatively recent and most of patients are treated with catheters.
Thirty-seven patients who require chronic hemodialysis with catheters were evaluated during a 3-years period in order to facilitate the creation of a permanent vascular access for hemodialysis (AVF). Patient selection were made during a multi-disciplinary consultation. The sex-ratio was 1.5 and the main cause of the nephropathy was arterial hypertension.
Thirty-one patients benefited from the creation of an arterioveinous fistula. All of the interventions were performed using local or loco-regional anesthesia. Sixty percent of these AVF were radio-cephalic, 35.4% were humero-cephalic. Sixty-four percent of the operations were performed on ambulatory patients, with a primary function for 90% of them.
This work proves the feasibility of the creation of AVF in Rwanda, thus allowing to preclude the various complications that arise with the prolonged use of a catheter. This experience was made possible by the pooling of the resources of 4 of Rwanda's leading hospitals. In an early future, the development of vascular surgery will assure the permanence of this care.