Perceived barriers and attitudes toward arteriovenous fistula creation and use in hemodialysis patients in Palestine

Knowledge, attitudes, and practices toward training of vascular access in chronic hemodialysis patients among nephrology fellows in Southwest China

This cross-sectional study examined the knowledge, attitudes, and practice (KAP) of training of vascular access in chronic hemodialysis patients among nephrology fellows in Southwest China. Nephrology fellows in Southwest China were recruited from June 1st to 10th, 2024. The demographic characteristics and KAP scores were determined using a self-designed questionnaire. Finally, 210 valid questionnaires were included. Among the participants, 37.6% were 36-40 years old, and 54.3% were females. The median knowledge, attitude, and practice scores were 19 (IQR: 17-20) (possible maximum of 20), 36 (IQR: 35-37) (possible maximum of 50), and 46 (IQR: 38-60) (possible maximum of 80), respectively. Knowledge and attitudes were correlated (Pearson's r = 0.439, P < 0.001), as well as knowledge and practice (r = 0.645, P < 0.001) and attitudes and practice (r = 0.560, P < 0.001). Mediation analysis showed that the knowledge scores (β = 0.266, P < 0.001), attitude scores (β = 0.268, P < 0.001), gender (β=-0.149, P = 0.001), nephrology experience (β = 0.135, P = 0.005), and experience of leading a vascular access-related surgery or procedure (β=-0.374, P < 0.001) had direct influences on practice, while the knowledge scores (β = 0.130, P < 0.001), professional background (β=-0.186, P < 0.001), and experience of leading a vascular access-related surgery or procedure (β=-0.070, P = 0.006) had indirect influences on practice. The study indicated that nephrology fellows in Southwest China had good vascular access knowledge but moderate attitudes and practices. Specific areas would require training to improve the practice of vascular access for patients requiring maintenance hemodialysis.

Knowledge, attitudes and practices regarding arteriovenous fistulas among uremic patients undergoing haemodialysis in China: a cross-sectional study

OBJECTIVES

This study aimed to investigate the relationship between knowledge, attitude and practice (KAP) regarding arteriovenous fistula (AVF) care in uremic patients undergoing haemodialysis (HD).

DESIGN

A web-based cross-sectional study was conducted among uremic patients receiving HD at the First Affiliated Hospital of Chongqing Medical University between April 2023 and June 2023.

SETTING

The study took place at the First Affiliated Hospital of Chongqing Medical University.

PARTICIPANTS

A total of 522 valid questionnaires were collected from patients undergoing HD, representing 85.57% of the 610 patients eligible for the study.

INTERVENTIONS

Pathway analysis was used to assess the interplay among KAP scores related to AVF care in the participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study evaluated KAP scores (ranging 0-20, 8-40 and 6-30, respectively) to gauge patients' KAP regarding AVF care.

RESULTS

The findings indicated that patients exhibited adequate knowledge, positive attitudes and proactive practices towards AVF care. Patients' knowledge directly influenced their attitudes and practices, with attitudes also positively impacting practices. Additionally, knowledge indirectly affected practices through attitudes.

CONCLUSIONS

Uremic patients undergoing HD demonstrated satisfactory understanding, favourable attitudes and proactive behaviours concerning AVF care. The pathway analysis provided insights into the relationships between KAP, illustrating the direct and indirect effects of these factors on each other in the context of AVF care among patients.

Determining the effect of arteriovenous fistula care training on the self-care behaviors of hemodialysis patients

INTRODUCTION

The aim was to determine the effect of arteriovenous fistula (AVF) care training given to hemodialysis (HD) patients on the self-care behaviors of patients.

METHODS

The randomized controlled experimental study was conducted in the HD unit. The study was carried out with a total of 66 patients. Patients in the intervention group were trained using the AVF Care Education Book for 4 weeks. The study data were collected using the scale for evaluating self-care behaviors related to AVF in HD patients (ASBHD-AVF). Shapiro-Wilk and Kolmogorov-Smirnov tests, independent t-tests, and ANOVA were used in the SPSS 25.0 package program.

RESULTS

As a result of the research, it was determined that the average ASBHD-AVF score of the patients in the trained intervention group increased from 54.52 ± 7.41 to 73.77 ± 3.05 (p <0.05). The mean ASBHD-AVF score of the patients in the control group increased from 56.14 ± 4.51 to 58.14 ± 5.93 (p >0.05). When the difference between the two groups was examined, it was determined that the average ASBHD-AVF score of the patients in the intervention group was statistically significantly higher than the control group (p <0.05).

CONCLUSION

AVF care education given to HD patients improves patients' self-care behaviors. Improved fistula self-care behaviors of patients will contribute to the healthy functioning of the AVF and the effective HD treatment of patients.

Impact of arteriovenous fistula aneurysms on a UK dialysis populations' perception of vascular access

BACKGROUND

Clinically-oriented outcome measures are increasingly being recognized as lacking in consideration of factors important to patients. There is an emerging move of guideline bodies advocating a more patient-centred approach. Aneurysms in autogenous arteriovenous fistula (AVF) can be considered unsightly and a constant reminder for patients of their dependence on dialysis. However, their impact on patient's perception has not previously been reported.

METHODS

Between April 2017-18, the Vascular Access Questionnaire (VAQ) was administered to prevalent haemodialysis patients across ten dialysis units via structured interviews, as part of a quality improvement project. Data for the subgroup of patients with aneurysmal AVF (categorised as per classification by Valenti et al.), were retrospectively evaluated and compared to the wider cohort.

RESULTS

Data were collected for 539 patients (median age: 66 years; 59% male), of whom 195 (36%) had aneurysmal AVF, with Type 2 morphology (cannulation site) being the most common (75%). Duration of AVF was found to be significantly associated with aneurysmal development, with estimated likelihoods of 11%, 43% and 61% after one, five and ten years, respectively. Interestingly, patients with diabetes had a significantly lower prevalence of aneurysmal development than those that were non-diabetic (25% vs. 43%, p < 0.001). Overall VAQ scores were not found to differ significantly by aneurysm status (p = 0.816) or across morphology types (p = 0.277). However, patients with aneurysmal AVF were significantly more concerned with the appearance of their AVF (p < 0.001) than the wider cohort. Despite this, patients with aneurysmal AVF gave significantly higher scores for satisfaction and ease of use and lower scores for bruising and clotting (p < 0.05).

CONCLUSIONS

Aneurysmal AVF are often cited as an important factor by patients for not proceeding with fistula formation. In this evaluation of patient reported experiences, those with aneurysmal AVF reported high satisfaction levels. This may help clinicians highlight positive patient reported outcomes of aneurysmal AVF during preprocedural consent processes.

Exploring Health Literacy and Vascular Access Decision Making: A Scoping Review

One in seven adults in the United States has chronic kidney disease (CKD) and individuals with the most severe form, end stage kidney disease (ESKD), may require renal replacement therapy with hemodialysis. Despite well-established guidelines indicating that arteriovenous access is the preferred type of vascular access for hemodialysis, in 2021, 85.4% of patients initiated dialysis with a CVC. While the reasons for this evidence-practice gap are unclear, health literacy and patient disease-specific knowledge may play an important role. Importantly, 25% of patients with CKD have limited health literacy. While there is an abundance of research regarding the presence of poor health literacy, poor kidney disease-specific knowledge, and their association with health outcomes in patients with CKD, there is currently a paucity of data about the relationship between health literacy, vascular access-specific knowledge, and vascular access outcomes. The aim of this narrative review is to describe the relationship between health literacy, disease-specific knowledge, and vascular access in patients with CKD. A better understanding of health literacy in this population will help inform the development of strategies to assess patient vascular access-specific knowledge and aid in vascular access decision making.

The stuck haemodialysis catheter-a case report of a rare but dreaded complication following kidney transplantation

BACKGROUND

Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming 'stuck' via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period.

CASE PRESENTATION

A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications.

CONCLUSIONS

This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.

Illness Denial in Medical Disorders: A Systematic Review

INTRODUCTION

Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment.

OBJECTIVE

This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders.

METHODS

The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science.

RESULTS

The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation.

CONCLUSIONS

This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

BACKGROUND

Little is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure.

METHOD

We followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded.

RESULTS

We identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17-52% (cancer), 25-47% (chronic kidney disease) and 0.2-80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality.

CONCLUSION

Although needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.

Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

Background

Impact of hemodialysis adequacy on patient survival is extensively studied. The current study compares the survival of chronic hemodialyzed, undocumented, uninsured, Afghan immigrant patients with that of a group of insured Iranian patients matched for underlying disease, age, weight, level of education, marital status, income, and number of comorbid conditions.

Methods

Eighty chronic hemodialysis patients (mean age 42.8 ± 10.5 years) entered this historical cohort study in Mashhad, Iran, between January 2012 and January 2015. Half of the patients were undocumented, uninsured, Afghan immigrants (Group A) matched with forty insured Iranian patients (Group B). To compare the survival rate of the two patient groups, Kaplan–Meir survival analysis test was used.

Results

Group A patients were underdialyzed with a weekly Kt/V which was significantly less in comparison with that of Group B (1.63 ± 0.63 versus 2.54 ± 0.12, p value = 0.01). While Group A's number of hemodialysis sessions per week was fewer than that of Group B (1.45 ± 0.56 versus 2.8 ± 0.41, p value = 0.04), the mean of Kt/V in each hemodialysis session was higher in them, in comparison with Group B (1.43 ± 0.25 versus 1.3 ± 0.07, p value = 0.045). In Group B and Group A patients, one-year survival was 70% versus 50%, two-year survival was 55% versus 30%, and three-year survival was 40% versus 20%, respectively (p values = 0.04, 0.02 and 0.04, respectively). In Cox regression analysis, hemodialysis adequacy and uninsurance were factors impacting patients' survival (OR = 1.193 and 0.333, respectively).

Conclusions

Undocumented, uninsured, inadequately hemodialyzed, Afghan patients had a significantly lower one-, two-, and three-year survival as opposed to their Iranian counterparts, probably due to lack of insurance.