Dialysis Access in a Resource Limited Environment and Establishing Autogenous Vascular Access in the Developing World Through Surgical Missions

Multiple publications have demonstrated increased mortality and morbidity for chronic disease patients in the United States territories compared to the 50 states. Puerto Rico’s renal community experiences multiple challenges regarding timing of care and sub-specialty availability. Vascular access is a critical issue for hemodialysis patients in Puerto Rico. Lower socio-economic status, a lower rate of pre-dialysis patients receiving nephrology care, a limited number of surgeons and other specialists including interventionalists, and very few dedicated vascular access care centers for patients are some of the challenges dialysis patients face in a limited resource environment. Identifying these challenges is an important step toward designing strategies for healthcare programs to prevent and adequately treat these problems. Worldwide, approximately two million individuals receive renal replacement therapy with more than one million deaths yearly due to untreated kidney failure, the majority in developing countries. We review our experience and outcomes with surgical vascular access missions in middle- and lower-income countries. Our goals are to create a safe and functional autogenous vascular access for individual patients while training local surgeons and healthcare providers, leaving a sustainable and lasting influence at each site.