Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients
Hemodialysis (HD) guidelines recommend permanent vascular access (PVA) in children unlikely to receive kidney transplant within 1 year of starting HD. We aimed to determine predictors of primary and secondary patency of PVA in pediatric HD patients.
Retrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome.
There were 103 arterio-venous fistulae (AVF) and 14 AV grafts (AVG). AVF demonstrated superior primary (p = 0.0391) and secondary patency (p = 0.0227) compared to AVG. Primary failure occurred in 16 PVA (13.6%) and secondary failure in 14 PVA (12.2%). AVF were more likely to have primary failure (odds ratio (OR) = 2.10) and AVG had more secondary failure (OR = 3.33). No demographic, clinical, or laboratory variable predicted primary failure of PVA. Anatomical location of PVA was predictive of secondary failure, with radial having the lowest risk compared to brachial (OR = 12.425) or femoral PVA (OR = 118.618). Intervention-free survival was predictive of secondary patency for all PVA (p = 0.0252) and directly correlated with overall survival of AVF (p = 0.0197) but not AVG. Study center demonstrated statistically significant effect only on intervention-free AVF survival (p = 0.0082), but not number of complications or interventions, or outcomes.
In this multi-center pediatric HD cohort, AVF demonstrated primary and secondary patency advantages over AVG. Radial PVA was least likely to develop secondary failure. Intervention-free survival was the only predictor of secondary patency for AVF and directly correlated with overall access survival. The study center effect on intervention-free survival of AVF deserves further investigation.
KeywordsPediatric hemodialysis Arteriovenous fistula Arteriovenous graft Primary patency Secondary patency
Compliance with ethical standards
Each participating center obtained approval for retrospective data collection from their local institutional review boards (IRB). None of the contributors from the respective dialysis centers had reported any conflict of interests.
- 1.US Renal Data System (2012) USRDS 2012 Annual Data Report. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, MDGoogle Scholar
- 8.Vascular Access Work Group (2006) NKF-DOQI Clinical practice guidelines for vascular access. Am J Kidney Dis 48(Suppl 1):S248–S273Google Scholar
- 16.Chand DH, Geary D, Patel H, Greenbaum LA, Nailescu C, Brier ME, Valentini RP (2015) Barriers, biases, and beliefs about arteriovenous fistula placement in children: a survey of the International Pediatric Fistula First Initiative (IPFFI) within the Midwest Pediatric Nephrology Consortium (MWPNC). Hemodial Int 19:100–107CrossRefGoogle Scholar
- 30.Knops NBB, Marien N, Lilien MR, Tordoir JHM, Oosterveld MJS (2013) Success rate and survival of arteriovenous fistula surgery in children: a retrospective multi-center study. Pediatr Nephrol 28:1371–1372Google Scholar
- 36.Dundon BK, Torpey K, Nelson AJ, Wong DTL, Duncan RF, Meredith IT, Faull RJ, Worthley SG, Worthley MI (2014) The deleterious effects of arteriovenous fistula creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. Int J Nephrol Renovas Dis 7:337–345Google Scholar