World Kidney Day as a Platform for Action: Early Outcomes of a Vascular Access Mission in Sub-Saharan Africa

Abstract

Background and aim Resource-limited settings in sub-Saharan Africa face critical barriers to arteriovenous fistula (AVF) creation, forcing hemodialysis patients into prolonged dependence on catheters, with the associated risks of infection and increased mortality. Ngaoundéré, a referral city in northern Cameroon, launched chronic hemodialysis services in February 2023 but lacks a resident vascular surgeon. Consequently, nearly all incident patients initiate hemodialysis using temporary central venous catheters (CVCs), a practice associated with well-documented complications. This retrospective analysis evaluates the outcomes of a Vascular Access Surgical Mission implemented over three annual cycles (March 2023 to March 2025) synchronized with World Kidney Day events. The primary objectives were to assess the feasibility of AVF creation and the rate of functional maturation at three months. Secondary objectives included evaluating procedural safety, early complication rates (thrombosis and stenosis), the reduction in catheter-associated bloodstream infections, achievement of catheter independence, and patient-reported quality of life. An exploratory, hypothesis-generating analysis was also conducted to identify potential risk factors associated with maturation failure. Methods We retrospectively reviewed clinical records of 35 adult patients who underwent AVF creation at Ngaoundéré Regional Hospital during three surgical missions (March 2023, March 2024, and March 2025). Data were extracted from pre-operative assessments, hemodialysis files, post-operative records, and ultrasound reports. Primary outcomes were AVF creation feasibility and functional maturation (per Kidney Disease Outcomes Quality Initiative {KDOQI} criteria) at three months. Secondary outcomes included procedural safety, early complications, and infection rates. Historical comparator data were reviewed for infection comparisons. Patient satisfaction was assessed via a custom Likert-scale questionnaire. Results Of 35 enrolled patients (mean age 40±12 years; 63% male), 34 AVFs were successfully created (97.1%, 95% CI: 85.1-99.5%). Functional maturation occurred in 29 of 32 patients who completed the three-month follow-up (90.6%, 95% CI: 75.8-96.8%). One early thrombosis (2.9%) was successfully salvaged; two cases of early stenosis (5.9%) required revision. No catheter-associated bloodstream infections (CABSI) occurred in AVF users (0 per 1,000 AVF-days) compared with 5.0 per 1,000 catheter-days in the historical comparator. Catheter dependence fell from 100% to 12.5% at three months. Patient satisfaction was high (92% reported reduced anxiety regarding infection; 94% would recommend the program). These early maturation rates provide a foundation for assessing long-term durability; 12- and 24-month patency data are currently being collected and will be critical for establishing sustained clinical benefit. Conclusions When combined with point-of-care imaging, equity-focused patient prioritization, and structured follow-up, mission-based surgical delivery can achieve high rates of AVF creation and functional maturation, with early outcomes comparable to those reported in high-resource settings in the context of a feasibility study. However, the model as implemented represents a hybrid approach requiring continued external surgical expertise rather than fully independent local capacity. Long-term patency validation and sustained investments in local capacity are essential.