Assessment Of Knowledge And Self-Care Behaviours Regarding Arteriovenous Fistula Among Patients With End-Stage Renal Disease In Pakistan. A Cross-Sectional Study

Abstract

Objective: To evaluate ESRD patients' awareness and understanding of self-care for AVF maintenance and explore the association, such as demographic and clinic characteristics that are associated with awareness and motivation for caring for AVF. Methods: This descriptive cross- sectional study was conducted over a period of six months in tertiary care hospitals affiliated with Rawalpindi Medical University, Pakistan. Sixty adult  patients with ESRD receiving regular haemodialysis were enrolled using a non-probability consecutive sampling method. A validated structured questionnaire was used to collect data on demographic and clinical characteristics, as well as information related to AVF self-care knowledge  and practice. Statistical  analysis: All statistical analyses were performed using SPSS version 27. Descriptive statistics were used to summarise participant characteristics, and Chi-square or Fisher’s exact test was used to ascertain demographic relationships with awareness of AVF self-care. Crude odds ratios (ORs) with 95% confidence intervals (CIs) were reported, and p<0.05 was considered statistically significant. Results: The mean age of the participants was 50.2 ± 13.6 years, and sex distribution was equal (50% male and 50% female). The most common comorbidities were hypertension (66.7%) and diabetes mellitus (55%). Ninety per cent perceived AVF to be superior to catheters, but only 16.7% examined for vascular thrill, and 38.3% practiced adequate hygiene. Knowledge on avoidance of sleeping on the AVF limb (56.7%), heavy lifting (45 %), tight clothing (35 %), and unnecessary needling puncture pricks (30%) was insufficient. This awareness and motivation were significantly higher in females, those with higher  education levels, and patients with diabetes (p < 0.05). Patients treated two times per week  had more compliant behaviour with respect to AVF care than those treated three times weekly (p = 0.049). Conclusion: While most patients  with ESRD are aware of the benefits of AVF, significant gaps in self-care activities remain. Gender, education, co-morbidity, and dialysis number were significant predictors of the  aware and motivated status. Structured innovation of patient education and counselling mechanisms is necessary to improve AVF  self-care procedures, minimise access-related complications, and enhance haemodialysis outcomes. Keywords: Arteriovenous fistula, awareness, end-stage renal disease, hemodialysis, patient education, self-care, vascular access.