Vascular Access Creation and Care--Perspective From India.

India has one of the fastest growing economies in the world and is home to nearly one sixth of world's population. Chronic diseases such as diabetes mellitus and hypertension are common. Kidney disease is a known complication of these chronic diseases and is on the rise. Improving affordability with advanced care delivery has led to the increasing use of maintenance hemodialysis. Along with this hemodialysis comes the inevitable need for vascular access. Interventional nephrology in India is a fast-evolving discipline and promises to be a critical component of hemodialysis care in the future. This review provides a background on the current state of the CKD burden in India and the various vascular access options in use currently. In addition, we describe the experience of 2 centers in western and southern India in managing vascular access needs in hopes that they will serve as a model of the proliferation of vascular access care throughout India and in other developing countries.

The current state of interventional nephrology in India.

Nephrologists in India have embraced providing complete care to their patients and recognize the benefits of coordinated care. This review describes the practice of interventional nephrology in India. Even though the benefits of using tunneled catheters over nontunneled catheters are well recognized, the use of nontunneled catheters is preferred, primarily because of financial constraints and the lack of training facilities. Arteriovenous fistulas (AVFs) are the most common form of dialysis vascular access, often created by nephrologists. Upper arm AVF and arteriovenous grafts are uncommon. The implementation of surveillance tests and elective endovascular interventions on arteriovenous accesses is limited in India, compared to being a routine practice in the United States. The clinical experience from a center in Southern India is described here to show the current state of procedural nephrology practice in India.