Cardiovascular Journal of Africa: Vol 32 No 2 (MARCH/APRIL 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 2, March/April 2021 AFRICA 101
Prospective data collection and interval evaluation: having
a registry of vascular access data can help to plan resource
allocation, guide the design of future clinical trials and monitor
the local vascular access practice. There is currently no prospective
registry for vascular access in South Africa, although the South
African Renal Registry does collect data on haemodialysis across
South Africa.25 The newly established registry of the African
Association of Nephrology will collect valuable data on CKD
management across Africa but lacks data collection on vascular
access.26 Adding vascular access data to these registries would be
beneficial to the African dialysis population.
Conclusion
It is a great privilege to be able to offer chronic haemodialysis
to our patients. To make the most use of this service we need to
optimise their vascular access. Our current practice falls short
of local and international guidelines in terms of AVF and CVC
use. The overwhelming majority of patients start dialysis with a
CVC rather than a recommended pre-emptive AVF and there are
significant delays prior to the first AVF creation. This translates
to a longer time using a CVC and increased complications as well
as limiting future access options. Recommendations to improve
the service would be to create a multidisciplinary vascular access
clinic, establish a dedicated vascular access theatre list and
assign an access co-ordinator. Ongoing education of healthcare
practitioners on the earlier identification and referral of kidney
disease will facilitate pre-emptive creation of vascular access.24
Finally, there is also a need for a South African vascular access
registry to identify the local practices of each haemodialysis unit.
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