Factors Associated to Vascular Access Choice Renal Failure Patient: The Greek Experience

Abstract Objective: In this study, we evaluated vascular access in Hemodialysis (HD) patients on Greek society by measure several factors, including the various types and the cost of vascular access under the current economic crisis. Methods: We recorded the characteristics and the cost of 2.586 HD patients, having in mind the hospitalization days and the form of vascular access. This specimen represents the 27,1% total patients in Greece, according the Greek Department of Coordination and Control Program for ESRD (YSE). The calculated cost included consumables, drugs, food, medical and administrative salaries, all covered by the state insurance in case vascular access is performed in public hospitals, while there is a fee payable from the same patients in case vascular access is performed in private clinics. Results: The mean patient age of our specimen was 68,7±14,1 years. 58,1% of the specimen is undergoing dialysis for a period of 1-5 years. 60,1% of the whole group prefers a private clinic, while the rest 39,9% a public hospital. Most common ESRD cause is diabetes with 19,8%, while “unknown” holds 33% of our group. Regarding vascular access, 58,3% have fistula, 25,5% use double lumen permanent catheter, while the rest 16,2%use graft. The major part of the mean cost for HD vascular access is covered by patients’ insurance and an amount by the patient. Mean one-time cost for each type of vascular access was €616,8±299,7for Catheter, €1.197,4±296,6 for Graft and €908±298,6 for Fistula respectively. State insurance is covering 99,6% of our patients, while only 0,4% has a private one. Conclusion: Patients with end-stage renal insufficiency due to the economic crisis make their vascular access to a public hospital instead of a private clinic. Keywords: Vascular access; Insurance cost; State cost; Health economics; Hemodialysis