Analysis of Characteristics and Management of Vascular Access in Patient on Hemodialysis at a Private Facility in Botswana: A Retrospective Study Conducted at Sidilega Private Hospital
Abstract:
End-stage renal disease (ESRD) imposes a growing global
burden, with haemodialysis as the primary therapy and vascular access
recognized as its critical “lifeline.” Arteriovenous fistulae (AVFs) provide
the best outcomes, whereas central venous catheters (CVCs) carry markedly
higher risks of infection, thrombosis, and mortality. In sub-Saharan Africa,
late referrals and limited surgical capacity contribute to heavy catheter
dependence, yet data from Botswana remain scarce. This retrospective cohort
study evaluated 273 haemodialysis patients at Sidilega Private Hospital
(Gaborone, Botswana) from February 2022 to February 2024 to describe vascular
access patterns, complications, and predictors of adverse outcomes.
Demographic, clinical, and procedural variables were collected from dialysis
and theatre records and analyzed using descriptive and multivariable
statistical methods. The cohort had a mean age of 48.6 years and was 59% male.
Hypertension and cardiovascular disease were highly prevalent (each >80%),
and 27.4% of patients presented with sepsis on admission. AVFs were created in
72.2% (197/273) of cases; however, 44.2% had prior catheter-based access,
demonstrating persistent reliance on temporary access modalities. Complications
included stenosis (35.2%), thrombosis (19.0%), and infection (14.7%). Access
type emerged as the strongest predictor of complications: compared with AVFs,
arteriovenous grafts (AVGs) showed significantly higher odds (OR ≈13.2) and
CVCs moderately higher odds (OR ≈6.7) of any complication. Despite the
complexity of cases, overall patency at discharge exceeded 95%, and in-hospital
mortality was low (2.2%). These findings highlight continued dependence on
catheter-based access and reinforce AVFs as the safest modality. Early nephrology
referral, structured vascular access programs, and national AVF targets are
essential to improve outcomes and align Botswana’s practice with global
standards.
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