Problematic of vascular access for hemodialysis in sub-saherienne africa: experience of dakar

Abstract

Aim: Vascular access is important for a good survive in hemodialysis. It can be temporary or permanent, and needs particular attention because of possible complications, especially infectious. We conducted a study to determine the type and the outcome of vascular access in two hemodialysis units in Dakar. Materials and Methods: A multicenter retrospective study was conducted from the 1st January 2005 to 10 September 2010 in two hemodialysis centers: Hospital Aristide Le Dantec and the MDTC (Multifunctional Diagnosis and Treatment Center) of Dakar. All the patients- regularly dialyzed since at least three months in these centers were included. Results: Sixty five patients were included. The mean age was 50.2 years with a sex ratio of 1.7. The mean duration in hemodialysis was 23.2 month. Only five patients (7.80%) had an AVF before starting in hemodialysis. Sixty patients (92.2%) started dialysis with a central venous catheter. Among them, 49 (81.6%) had a double lumen femoral catheter and 11 had a jugular one with 4 tunneled. Complications of vascular access were noted for 23 patients (39.7%) with 12 infections. Blood culture was positive for Staphylococcus Aureus in seven cases. Seven patients presented lower limb thrombophlebitis. Thrombosis of the catheter was noted in four patients. Radial arterio-venous fistula (AVF) was the first intention permanent access in 41 cases (64.1%) followed by cephalic AVF in 14 cases (21.9%) and basilic AVF in 9 (14%). AVF complications were presented in 56.9% of case (40 patients). Most of them was early defect in 18 cases (27.7%), thrombosis in 9 (13.8%) and stenosis in 5 (7.7%). Radial AVF infection to Staphylococcus Aureus was noted in 3 cases, and one pseudo aneurysm was noted. Conclusion: Vascular access for hemodialysis is a great problem in Senegal. More than two third of our patients start dialysis on venous catheters, this is far from the clinical practice guidelines.