Vascular access in Pará: clinical and epidemiological aspects of patients on renal replacement therapy at the largest specialist center in Pará state, Brazil.

Background: There are no official data on the prevalence of end-stage chronic kidney disease with dialysis for the Brazilian state of Pará. Objectives: To describe the clinical-epidemiological profile of hemodialysis patients at the largest specialist center in the state of Pará. Methods: This is an observational, cross-sectional, descriptive, quantitative study. Simple descriptive statistics were calculated. Data were collected from medical records from June to August 2022 at the Hemodialysis Center at the Hospital de Clínicas Gaspar Vianna (HCGV) and the Monteiro Leite Hemodialysis Clinic (CMHL), both in Belém, Pará, Brazil. A total of 191 patients from the chronic hemodialysis program were interviewed. Results: Of the total sample, 28.8% patients were from HCGV and 71.6% from CHML; 57.1% were men and 42.9% were women. Mean age was 54.1 years. Results showed that 65.4% of patients self-reported skin color as brown, 44.5% had completed primary education, 41.9% were single, 71.4% had hypertension, 40.6% had diabetes, and 77.5% had been on renal replacement therapy for a mean time of 4 years. Regarding treatment, 86.9% started treatment with a short-duration catheter, 8.4% were using a long-dwelling catheter, and 4.7% had a definitive dialysis access via a mature arteriovenous fistula (AVF). Currently, 58.1% of these patients have a native AVF, 34% have a long-dwelling catheter, and 3.1% have a short-duration catheter and no AVF. Conclusions: Patients on renal replacement therapy in Pará predominantly initiate hemodialysis in an unplanned manner, using temporary venous catheters, although they transition to definitive vascular access over time. This scenario highlights the need for early diagnosis of chronic kidney disease and timely vascular access planning, aiming to reduce complications and optimize clinical outcomes.