title: Vascular access in patients receiving hemodialysis in Libya.
abstract: OBJECTIVE
  A native arteriovenous fistula (AVF) represents the optimal form of Vascular Access (VA) for patients receiving hemodialysis (HD). In Libya there are several barriers to AVF creation including lack of adequate preparation for dialysis and surgical services. We aimed to conduct the first comprehensive study of VA utilisation in HD patients in Libya.
  
  
  METHODS
  A prospective observational study included all adult patients receiving HD treatment in 25 HD facilities in Libya from May 2009 to Nov 2011. Researchers gathered data regarding VA through interviews with staff and patients as well as medical records. Patients with definitive VA were re-interviewed after 1 year.
  
  
  RESULTS
  At baseline the majority of patients (91.9%; n=1573) were using permanent VA in the form of AVF or arteriovenous graft. Patients with permanent VA were more likely to be male and less likely to be diabetic than those with CVCs. Most patients had commenced HD using a temporary CVC (91.8%). VA-related complications were: thrombosis (46.7%), aneurysm (22.6%), infection (11.5%) and haemorrhage (10.2%). Incident VA thrombosis was reported by 14.7% in 1 year. Independent risk factors for incident thrombosis were female gender and diabetes. Hospitalisation for VA related complications was reported by 31.4%.
  
  
  CONCLUSIONS
  Few patients in Libya initiate HD with definitive VA, but most achieve it thereafter. Improved dialysis preparation and increased provision of surgical services are required to increase the proportion of patients initiating HD with definitive VA and should be a priority in rebuilding health services in Libya after the recent conflict.
authors.affiliation: School of Graduate Entry Medicine, University of Nottingham, Nottingham - UK and School of Medicine, University of Tripoli, Tripoli - Libya.
authors.forename: Wiam A
authors.initials: WA
authors.lastname: Alashek
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data; D003141:Communicable Diseases / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D019538:Health Care Surveys; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008002:Libya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome