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Predictors of time to first cannulation for arteriovenous fistula in pediatric hemodialysis patients: Midwest Pediatric Nephrology Consortium study

  • Ali Mirza OnderEmail author
  • Joseph T. Flynn
  • Anthony A. Billings
  • Fang Deng
  • Marissa DeFreitas
  • Chryso Katsoufis
  • Matthew M. Grinsell
  • Larry Patterson
  • Jennifer Jetton
  • Sahar Fathallah-Shaykh
  • Daniel Ranch
  • Diego Aviles
  • Lawrence Copelovitch
  • Eileen Ellis
  • Vimal Chadha
  • Ayah Elmaghrabi
  • Jen-Jar Lin
  • Lavjay Butani
  • Maha Haddad
  • Olivera Marsenic
  • Paul Brakeman
  • Raymond Quigley
  • H. Stella Shin
  • Rouba Garro
  • Hui Liu
  • Javad Rahimikollu
  • Rupesh Raina
  • Craig B. Langman
  • Ellen Wood
  • on behalf of the Midwest Pediatric Nephrology Consortium
Original Article
Part of the following topical collections:
  1. What's New in Dialysis

Abstract

Background

Permanent vascular access (PVA) is preferred for long-term hemodialysis. Arteriovenous fistulae (AVF) have the best patency and the lowest complication rates compared to arteriovenous grafts (AVG) and tunneled cuffed catheters (TCC). However, AVF need time to mature. This study aimed to investigate predictors of time to first cannulation for AVF in pediatric hemodialysis patients.

Methods

Data on first AVF and AVG of patients at 20 pediatric dialysis centers were collected retrospectively, including demographics, clinical information, dialysis markers, and surgical data. Statistical modeling was used to investigate predictors of outcome.

Results

First PVA was created in 117 children: 103 (88%) AVF and 14 (12%) AVG. Mean age at AVF creation was 15.0 ± 3.3 years. AVF successfully matured in 89 children (86.4%), and mean time to first cannulation was 3.6 ± 2.5 months. In a multivariable regression model, study center, age, duration of non-permanent vascular access (NPVA), and Kt/V at AVF creation predicted time to first cannulation, with study center as the strongest predictor (p < 0.01). Time to first cannulation decreased with increasing age (p = 0.03) and with increasing Kt/V (p = 0.01), and increased with duration of NPVA (p = 0.03). Secondary failure occurred in 10 AVF (11.8%). Time to first cannulation did not predict secondary failure (p = 0.29), but longer time to first cannulation tended towards longer secondary patency (p = 0.06).

Conclusions

Study center is the strongest predictor of time to first cannulation for AVF and deserves further investigation. Time to first cannulation is significantly shorter in older children, with more efficient dialysis treatments, and increases with longer NPVA duration.

Keywords

Hemodialysis Pediatric Arteriovenous fistula Arteriovenous graft Time to first cannulation Maturation time 

Notes

Supplementary material

467_2019_4396_MOESM1_ESM.docx (1.5 mb)
ESM 1 (DOCX 1570 kb)

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Copyright information

© IPNA 2019

Authors and Affiliations

  • Ali Mirza Onder
    • 1
    • 2
    Email author
  • Joseph T. Flynn
    • 3
  • Anthony A. Billings
    • 4
  • Fang Deng
    • 5
  • Marissa DeFreitas
    • 6
  • Chryso Katsoufis
    • 6
  • Matthew M. Grinsell
    • 7
  • Larry Patterson
    • 8
  • Jennifer Jetton
    • 9
  • Sahar Fathallah-Shaykh
    • 10
  • Daniel Ranch
    • 11
  • Diego Aviles
    • 12
  • Lawrence Copelovitch
    • 13
  • Eileen Ellis
    • 14
  • Vimal Chadha
    • 15
  • Ayah Elmaghrabi
    • 16
  • Jen-Jar Lin
    • 17
  • Lavjay Butani
    • 18
  • Maha Haddad
    • 18
  • Olivera Marsenic
    • 19
  • Paul Brakeman
    • 20
  • Raymond Quigley
    • 16
  • H. Stella Shin
    • 21
  • Rouba Garro
    • 21
  • Hui Liu
    • 22
  • Javad Rahimikollu
    • 4
  • Rupesh Raina
    • 23
  • Craig B. Langman
    • 5
  • Ellen Wood
    • 24
  • on behalf of the Midwest Pediatric Nephrology Consortium
  1. 1.Division of Pediatric NephrologyMemphisUSA
  2. 2.Division of Pediatric NephrologyBatson Children’s Hospital of Mississippi , University of Mississippi Medical CenterJacksonUSA
  3. 3.Division of Nephrology, Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of MedicineSeattleUSA
  4. 4.Department of Statistics, West Virginia UniversityMorgantownUSA
  5. 5.Kidney Diseases Division, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children’s Hospital of ChicagoChicagoUSA
  6. 6.Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children’s HospitalUniversity of Miami Leonard M Miller School of MedicineMiamiUSA
  7. 7.Division of Pediatric Nephrology, Primary Children’s HospitalUniversity of UtahSalt Lake CityUSA
  8. 8.Division of Pediatric NephrologyChildren’s National Health SystemWashingtonUSA
  9. 9.Division of Nephrology, Dialysis and TransplantationUniversity of Iowa Stead Family Children’s HospitalIowa CityUSA
  10. 10.Division of Pediatric Nephrology, Children’s of AlabamaUniversity of AlabamaBirminghamUSA
  11. 11.Division of Pediatric NephrologyUniversity of Texas Health Science CenterSan AntonioUSA
  12. 12.Division of Pediatric Nephrology, Children’s Hospital New Orleans, LSU Heath School of MedicineNew OrleansUSA
  13. 13.Division of NephrologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  14. 14.Division of Pediatric NephrologyArkansas Children’s HospitalLittle RockUSA
  15. 15.Division of Pediatric NephrologyChildren’s Mercy HospitalKansas CityUSA
  16. 16.Division of Pediatric NephrologyChildren’s Medical Center Dallas, UT SouthwesternDallasUSA
  17. 17.Division of Pediatric NephrologyBrenner Children’s Hospital, Wake Forest UniversityWinston SalemUSA
  18. 18.Division of Pediatric NephrologyUC Davis Children’s HospitalSacramentoUSA
  19. 19.Division of Pediatric NephrologyYale New Haven Children’s Hospital, Yale University School of MedicineNew HavenUSA
  20. 20.Division of Pediatric NephrologyUCSF Benioff Children’s HospitalSan FranciscoUSA
  21. 21.Division of Pediatric NephrologyChildren’s Healthcare of AtlantaAtlantaUSA
  22. 22.Division of General Academic PediatricsUniversity of Pittsburgh, School of MedicinePittsburghUSA
  23. 23.Division of Pediatric NephrologyAkron Children’s HospitalAkronUSA
  24. 24.Department of Pediatrics, Division of Pediatric Nephrology, SSM Cardinal Glennon Children’s HospitalSaint Louis UniversitySt. LouisUSA

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