The following is a summary of “Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas,” published in the May 2024 issue of Nephrology by Ghimire et al.

Data on global variations in vascular access for hemodialysis (HD) is still lacking, and extensive research is required to reach any conclusion.

Researchers conducted a retrospective study using the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) data to highlight the global differences in funding and availability of hemodialysis accesses. 

They surveyed key stakeholders affiliated with the ISN to learn about funding sources and types of vascular access used to start dialysis. Between June and September 2022, an electronic survey was sent to national, international, and regional stakeholders affiliated with the ISN. Participating countries were categorized by income level (based on the World Bank; low, lower-middle, upper-middle, and high-income) and regional affiliation with the ISN. 

The results showed that data from 160 countries were studied, and 22% (n=35) reported that >50% of HD starts with an arteriovenous fistula or graft (AVF/AVG). Higher rates in Western Europe (n=14, 64%) and North & East Asia (n=4, 67%), and among high-income countries (n=24, 38%). The rates of >50% of patients starting HD with a tunneled dialysis catheter were highest in North America and the Caribbean (n=7, 58%) and lowest in South Asia, Newly Independent States, and Russia (n=0). Respondents from 50% (n=9) of low-income countries, >75%, started HD with temporary catheters (50% highest in Africa – 75% and Latin America – 67%). Funding for vascular access creation was often made through public or free in high-income countries (67% for AVF/AVG, 70% for catheters), while low-income countries relied more on private or out-of-pocket funding (n=8, 40% for AVF/AVG, n=5, 25% for central venous catheters).

Investigators concluded that high-income countries use AVF/AVG and tunneled catheters in diverse ways. Conversely, low-income countries rely more on temporary dialysis catheters and private funding to create access.

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03593-z