Current state of dialysis access management in Korea. Issue 1 (May 2019)

• Record Type: Journal Article
• Authors: Kim, Yong-Soo; Kim, Yaeni; Shin, Seok Joon; Lee, Hyung Seok; Kim, Sung Gyun; Cho, Seong; Na, Ki Ryang; Kim, Jin Kuk; Kim, Seung Jung; Kim, Young Ok; Jin, Dong-Chan
• Is Part Of: Journal of vascular access. Volume 20:Issue 1(2019)Supplement
• Page Start: 15
• Page End: 19
• Publication Date: 2019-05
• Subjects: Renal replacement therapy -- vascular access -- peritoneal access -- interventional nephrology; Arterial catheterization -- Periodicals; Intravenous catheterization -- Periodicals; 612.13
• DOI: 10.1177/1129729818776913
• Languages: English
• ISSNs: 1129-7298

Abstract

The prevalence rate and the incidence rate of hemodialysis and functioning kidney transplant recipients have continuously increased; on the contrary, those of peritoneal dialysis have continuously decreased since 2006. Dialysis patients have been getting older and have been maintained on dialysis longer. Diabetic nephropathy was the leading cause of end stage renal disease. The type of hemodialysis vascular access has been stable during the last 5 years (arteriovenous fistulas 76%, arteriovenous grafts 16%, central venous catheters 8% at 2016). Peritoneal dialysis catheter was mostly inserted surgically (67%), and swan neck straight tip peritoneal dialysis catheter was the most commonly used (48%). Vascular access was managed by radiologists and surgeons, and the management was fragmented among them in the past. However, since the nephrologists became interested in and knowledgeable about the vascular access, they began to play roles in vascular access management. Vascular access has been mostly created by vascular surgeons (≈60%); tunneled central venous hemodialysis catheter insertion and endovascular intervention such as percutaneous transluminal angioplasty (PTA) and thrombectomy have been mostly performed by radiologists (≈70%). Tunneled hemodialysis catheter insertion and endovascular intervention by nephrologists have slowly but consistently increased. Recently, the number of central venous hemodialysis catheter insertion has decreased, and tunneled hemodialysis catheter has been inserted more than non-tunneled hemodialysis catheter, indicating that vascular access has been created timely and the vascular access team has been educated about and following international guidelines.