Patients’ Perspectives on Hemodialysis Vascular Access: A Systematic Review of Qualitative Studies

doi:10.1053/j.ajkd.2014.06.024

American Journal of Kidney Diseases

Volume 64, Issue 6, December 2014, Pages 937-953

https://doi.org/10.1053/j.ajkd.2014.06.024 Get rights and content

Background

Delayed creation of vascular access may be due in part to patient refusal and is associated with adverse outcomes. Concerns about vascular access are prevailing treatment-related stressors for patients on hemodialysis therapy. This study aims to describe patients’ perspectives on vascular access initiation and maintenance in hemodialysis.

Study Design

Systematic review and thematic synthesis of qualitative studies.

Setting & Population

Patients with chronic kidney disease who express opinions about vascular access for hemodialysis.

Search Strategy & Sources

MEDLINE, EMBASE, PsycINFO, CINAHL, reference lists, and PhD dissertations were searched to October 2013.

Analytical Approach

Thematic synthesis was used to analyze the findings.

Results

From 46 studies involving 1,034 patients, we identified 6 themes: heightened vulnerability (bodily intrusion, fear of cannulation, threat of complications and failure, unpreparedness, dependence on a lifeline, and wary of unfamiliar providers), disfigurement (preserving normal appearance, visual reminder of disease, and avoiding stigma), mechanization of the body (bonded to a machine, internal abnormality, and constant maintenance), impinging on way of life (physical incapacitation, instigating family tension, wasting time, and added expense), self-preservation and ownership (task-focused control, advocating for protection, and acceptance), and confronting decisions and consequences (imminence of dialysis therapy and existential thoughts).

Limitations

Non-English articles were excluded.

Conclusions

Vascular access is more than a surgical intervention. Initiation of vascular access signifies kidney failure and imminent dialysis, which is emotionally confronting. Patients strive to preserve their vascular access for survival, but at the same time describe it as an agonizing reminder of their body’s failings and “abnormality” of being amalgamated with a machine disrupting their identity and lifestyle. Timely education and counseling about vascular access and building patients’ trust in health care providers may improve the quality of dialysis and lead to better outcomes for patients with chronic kidney disease requiring hemodialysis.

Section snippets

Methods

We followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework.²³

Literature Search

Our search yielded 401 articles. Of these, 46 articles were included (Fig 1). One study did not report the number of patients. The other 45 articles involved 1,034 patients (761 were receiving hemodialysis; 67, peritoneal dialysis; 42, non–dialysis dependent; and 164, dialysis modality not specified; Table 1).

Comprehensiveness of Reporting

The completeness of reporting was variable, with studies reporting 5-23 of the 24 items possible (Table 2). The participant selection strategy was described in 39 (85%) studies.

Discussion

For patients requiring hemodialysis, creating a vascular access is more than a surgical intervention. Initiation of care measures aimed at establishing a vascular access for hemodialysis signifies kidney failure and imminent dialysis, which is emotionally confronting. Patients are acutely aware that their survival depends on a working vascular access and therefore strive to preserve it. At the same time, they describe it as an agonizing reminder of their body’s failings and “abnormality” of

Acknowledgements

Support: Dr Tong is supported by a National Health and Medical Research Council Fellowship (ID no. 1037162). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Financial Disclosure: The authors declare that they have no other relevant financial interests.

Contributions: Research idea and study design: JRC, CSH, WCW, JCC, SP, GFMS, AT; data

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: Because an author of this article is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an Associate Editor (Dorry L. Segev, MD, PhD) who served as Acting Editor-in-Chief. Details of the journal’s procedures for potential editor conflicts are given in the Information for Authors & Editorial Policies.

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Original InvestigationDialysisPatients’ Perspectives on Hemodialysis Vascular Access: A Systematic Review of Qualitative Studies

Background

Study Design

Setting & Population

Search Strategy & Sources

Analytical Approach

Results

Limitations

Conclusions

Section snippets

Methods

Literature Search

Comprehensiveness of Reporting

Discussion

Acknowledgements

Kidney Int

J Clin Epidemiol

Kidney Int

Am J Kidney Dis

Soc Sci Med

Patient Educ Couns

Kidney Int

Int J Nurs Stud

Am J Kidney Dis

Adv Chronic Kidney Dis

Hemodialysis vascular access morbidity

J Am Soc Nephrol

Late creation of vascular access for hemodialysis and increased risk of sepsis

J Am Soc Nephrol

Physiological and psychosocial stressors among hemodialysis patients in educational hospitals of Northern Iran

Indian J Palliat Care

Factors associated with treatment-related stressors in hemodialysis patients

ANNA J

Vascular access and all-cause mortality: a propensity score analysis

J Am Soc Nephrol

Type of vascular access and location in online hemodiafiltration and its association with patient's perception of health-related quality of life

J Vasc Access

Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making

Nephrol Dial Transplant

Association of initial hemodialysis vascular access with patient-reported health status and quality of life

Clin J Am Soc Nephrol

Re-envisioning Fistula First in a patient-centered culture

J Am Soc Nephrol

KDOQI clinical practice guidelines for vascular access

Am J Kidney Dis

Critical and honest conversations: the evidence behind the “Choosing Wisely” campaign recommendations by the American Society of Nephrology

Clin J Am Soc Nephrol

Patients, Doctors, and Medical Decisions

Preferences for dialysis withdrawal and engagement in advance care planning within a diverse sample of dialysis patients

Nephrol Dial Transplant

Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group

JAMA

Methods for the thematic synthesis of qualitative research in systematic reviews

BMC Med Res Methodol

Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ

BMC Med Res Methodol

Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32-item checklist for interviews and focus groups

Int J Qual Health Care

Living With an Arterio-Venous Fistula for Hemodialysis

Negotiating living with an arteriovenous fistula for hemodialysis

Nephrol Nurs J

The Experiences of ESRD Patients' Decision-Making Process and Adaptation to a Dialysis Treatment Modality in Taiwan

The experience of being 30–45 years of age and depending on haemodialysis treatment: a phenomenological study

Scand J Caring Sci

Experiencing Dialysis: A Descriptive Phenomenological Study of Nurses and Patients in Dialysis Satellite Units

Barriers to the Elective Start of Renal Replacement Therapy: What Are They, Why Do They Occur and How Can We Overcome Them?

Patients’ priorities for health research: focus group study of patients with chronic kidney disease

Nephrol Dial Transplant

Factors influencing patient selection of dialysis treatment modality

ANNA J

Transformations: a phenomenological investigation into the life-world of home haemodialysis

Soc Work Health Care

Patient's Choice…Is It? A Qualitative Study of Patients' Perceptions of Why, How, and By Whom Dialysis Treatment Modality Was Chosen

Patient's perceptions of why, how, and by whom dialysis treatment modality was chosen

ANNA J

Patient Decision Making Regarding Life-Sustaining Treatment for End-Stage Renal Disease

Engulfment Among Adults With Chronic Renal Disease: A Study of Self-loss and Its Correlates

Thai Patient's Experiences of End-Stage Renal Disease: A Path Through an Unknown World

Sensory and narrative identity: the narration of illness process among chronic renal sufferers in Ireland

Anthropol Med

Original Investigation
Dialysis
Patients’ Perspectives on Hemodialysis Vascular Access: A Systematic Review of Qualitative Studies