Quality in the assistance to the carrier of chronic renal disease: Factor associated to the provision of arteriovenous vascular access

Background: The creation of an arteriovenous vascular access before the start of a chronic hemodialysis is an ideal condition because it provides greater blood flow rates and is associated to much less rates of morbimortality than central venous catheter. Despite these practice patterns, in Brazil, 35% of dialysis services have more than 10% of maintenance hemodialysis patients chronically dialyzed using catheters (continuous use > three months). However, no information about factors associated with low provision of arteriovenous vascular access exists in Brazil.
Methods: “TRS Project –Economic and Epidemiological Evaluation of Renal Replacement Therapy in Brazil” was a cross-seccional study of patients with end-stage renal disease from dialysis services and transplant centers, nationally representative, in the year of 2007. The present investigation was limited to patients enrolled in “TRS Project” who had hemodialysis as first therapy modality (n=2278) and had reports first type of vascular access (arteriovenous vascular access or central venous catheter) in hemodialysis (n=2274). Multiple logistic regression analysis was used to evaluate the factors associated to arteriovenous vascular access use among these patients.
Results: Approximately 30% of the patients had arteriovenous vascular access. Multiple regression analysis revealed three factors associated to a lower likelihood of having an arteriovenous vascular access (economic, demographic and clinical factors). Specifically, the provision of arteriovenous vascular access was lower in patients without insurance coverage (OR 0.65, 95% IC, 0.53 to 0.80), no residents from capital cities (OR 0.79, 95% IC 0.64 to 0.96) and time of chronic renal disease diagnosis before initiating hemodialysis therapy less than 1 year (OR 0.30, 95% IC 0.25 to 0.37).
Conclusions: This suggests that predialysis care is not fair in Brazil and efforts to improve the provision of arteriovenous vascular access before or in the initial stages of hemodialysis  need to focus on regulation of providers units for managers.