Abstract
Background: Vascular access (VA) is a critical component of hemodialysis (HD). Arteriovenous fistulas (AVFs) are associated with lower morbidity and mortality compared to central venous catheters (CVCs). However, VA practice varies across different healthcare systems.
Objectives: The aim of our study was to evaluate the trends, costs, and distribution of VA types used in North Macedonia over two decades.
Methods: This retrospective study reviewed VA procedures performed at the University Clinic of Nephrology in Skopje from 2002 to 2023, highlighting trends and financial implications. Data on AVFs, tunneled central catheters (TCCs), and temporary catheters were collected and analyzed. Preoperative Doppler ultrasound assessments and follow-up evaluations were used to monitor AVF maturation and CVC placement. The cost analysis was based on the Diagnostic-Related Group coding system.
Results: A total of 25 532 VA procedures were performed, including 5798 AVFs (83% of permanent VA), 1199 TCCs (17%), and 18 535 temporary CVCs. The number of AVFs steadily increased during the whole of the analyzed period, except in 2020 due to the COVID-19 pandemic. Temporary femoral vein catheterization accounted for 90% of CVCs. The financial burden of VA increased from 6.6% of the clinic’s budget in 2018 to 9.3% in 2022, with a notable rise in CVC-related expenses.
Conclusions: In North Macedonia, use of temporary CVCs at dialysis initiation remains high. Increasing the number of preemptive AVFs and improving long-term VA planning are essential to optimize patient outcomes and reduce healthcare costs.
Keywords
vascular access; hemodialysis; arteriovenous fistula; catheter; budget
Resumo
Contexto: O acesso vascular (AV) é um componente fundamental da hemodiálise (HD). As fístulas arteriovenosas (FAVs) estão associadas a menor morbidade e mortalidade quando comparadas aos cateteres venosos centrais (CVCs). No entanto, a prática de AV varia entre diferentes sistemas de saúde.
Objetivos: O objetivo deste estudo foi avaliar as tendências, os custos e a distribuição dos tipos de AV utilizados na Macedônia do Norte ao longo de duas décadas.
Métodos: Este estudo retrospectivo revisou os procedimentos de AV realizados na Clínica Universitária de Nefrologia, em Skopje, de 2002 a 2023, destacando tendências e implicações financeiras. Dados sobre FAVs, cateteres centrais tunelizados (CCTs) e cateteres temporários foram coletados e analisados. O monitoramento da maturação das FAVs e da colocação dos CVCs foi realizado por meio de avaliações pré-operatórias com ultrassom Doppler e acompanhamento. A análise de custos baseou-se no sistema de codificação Diagnostic-Related Group.
Resultados: Foram realizados 25.532 procedimentos de AV, incluindo 5.798 FAVs (83% dos AVs permanentes), 1.199 CCTs (17%) e 18.535 CVCs temporários. O número de FAVs aumentou gradativamente ao longo do período analisado, exceto em 2020, devido à pandemia de covid-19. A cateterização temporária da veia femoral representou 90% dos CVCs. O impacto financeiro dos AVs passou de 6,6% do orçamento da clínica em 2018 para 9,3% em 2022, com aumento expressivo nas despesas relacionadas aos CVCs.
Conclusões: Na Macedônia do Norte, o uso de CVCs temporários no início da diálise permanece elevado. Aumentar o número de FAVs preventivas e melhorar o planejamento a longo prazo dos AVs são ações essenciais para otimizar os resultados dos pacientes e reduzir os custos com saúde.
Palavras-chave
acesso vascular; hemodiálise; fístula arteriovenosa; cateter; orçamento
References
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