Abstract
The aim of this study is to report a single-center experience regarding the management and outcome of permanent vascular accesses (VA) in children on chronic hemodialysis (HD). We analyzed the survival of permanent VA in 79 pediatric patients with end-stage renal disease patients on chronic HD between January 2000 and December 2008. One hundred and thirty-seven VA [89 native fistulas (AVFs) and 48 grafts (AVGs)] were created in 79 children. The creation of AVFs was significantly more frequent in children weighing >25 kg and AVGs in children weighing <25 kg (p = 0.003). The 1-year primary patency rate was 50% for AVF and 30% for AVG. The secondary patency rates at 1, 2, and 3 years for AVFs were 73, 50, and 20% and for AVGs were 64, 36, and 20%, respectively. The total number of surgical and endovascular interventions was significantly higher in AVGs (p ≤0.05). Access stenosis, thrombosis and infection episodes occurred more frequently in AVG (p = 0.02). VAs had a high rate of interventions. Our study demonstrated better results of AVFs formation over AVGs, for long-term HD access in pediatrics. Surveillance and radiologic procedures are necessary for early detection and treatment of access complications in order to extend access survival.
Similar content being viewed by others
References
Grimoldi IA, Briones LM, Ferraris JR, Rodriguez Rilo L, Sojo ET, Turconi A, Wainberg E, Zalba J, Sepliarsky A, Comité Nacional de Nefrología (2008) Chronic renal failure, dialysis and transplant: multicentric study 1996–2003. Arch Argent Pediatr 106:552–559
Chand DH, Valentini RP (2008) International Pediatric Fistula First Initiative: a call to action. Am J Kidney Dis 51:1016–1024
National Kidney Foundation (2006) KDOQI clinical practice guidelines and clinical practice recommendations for vascular access. Am J Kidney Dis 48:S176–S322
Sheth RD, Brandt ML, Brewer ED, Nuchtern JG, Kale AS, Goldstein SL (2002) Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease. Kidney Int 62:1864–1869
Goldstein SL (2007) Advances in renal replacement therapy as a bridge to renal transplantation. Pediatr Transplant 11:463–470
National Kidney Foundation (2000) K/DOQI Clinical Practice Guidelines for Vascular Access. Am J Kidney Dis 37:S137–S181
Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni RL (2004) Vascular access results from the dialysis outcomes and practice patterns study (DOPPS): performance against kidney disease outcomes quality (K/DOQI) clinical practice guidelines. Am J Kidney Dis 44:S22–S26
Fadrowski JJ, Hwang W, Neu AM, Fivush BA, Furth SL (2009) Patterns of use of vascular catheters for hemodialysis in children in the United States. Am J Kidney Dis 53:91–98
Verrina E, Edefonti A, Granoglio B, Rinaldi S, Sorino P, Zacchello G, Lavoratti G, Maringhini S, Pecoraro C, Calero MG, Turrini L, Perfumo F (2004) A multicenter experience on patient and technique survival in children on chronic hemodialysis. Pediatr Nephrol 19:82–90
Valentini RP, Geary DF, Chand DH (2008) CVL for chronic hemodialysis: survey of the Midwest Pediatric Nephrology Consortium. Pediatr Nephrol 23:291–295
Fischback M, Edefonti A, Schoeder C, Watson A (2005) Hemodialysis in children: general practical guidelines. The European Pediatric Dialysis Group. Pediatr Nephrol 20:1054–1066
Bourquelot P, Cussenot O, Corbi P, Pillion G, Gagnadoux MF, Bensman A, Loirat C, Broyer M (1990) Microsurgical creation and follow-up of arteriovenous fistulae for chronic hemodialysis in children. Pediatr Nephrol 4:156–159
Bourquelot P, Raynaud F, Pirozzi N (2003) Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases. Ther Apher Dial 7:498–503
Bourquelot P (2009) Vascular access for haemodialysis. Néphrol Thér 5:239–248
Bagolan P, Spagnoli A, Ciprandi G, Picca S, Leozappa G, Nahorn A, Trucchi A, Rizzoni G, Fabbrini G (1998) A ten year experience of Brescia Cimino arteriovenous fistula in children: technical evolution and refinements. J Vasc Surg 27:640–644
Sanabia J, Polo JR, Morales MD, Canals MJ, Polo J, Serantes A (1993) Microsurgery in gaining paediatric vascular access for haemodialysis. Microsurgery 14:276–279
Gradman WS, Lerner G, Mentser M, Rodriguez H, Kamil ES (2005) Experience with autogenous arteriovenous access for hemodialysis in children and adolescents. Ann Vasc Surg 19:609–612
Ramage IJ, Bailie A, Tyerman KS, McColl JH, Pollard SG, Fitzpatrick MM (2005) Vascular access survival in children and young adults receiving long-term hemodialysis. Am J Kidney Dis 45:708–714
Lumsden AB, Mac Donald MJ, Allen RC, Dodson TF (1994) Hemodialysis access in the pediatric population. Am J Surg 168:197–201
Zaritsky JJ, Salusky IB, Gales B, Ramos G, Atkinson J, Allsteas A, Brandt ML, Goldstein SL (2008) Vascular access complications in long-term hemodialysis patients. Pediatr Nephrol 23:2061–2065
Chand DH, Valentini RP, Kamil ES (2009) Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners. Pediatr Nephrol 24:1121–1128
Maya ID, Allon M (2008) Vascular access: core curriculum 2008. Am J Kidney Dis 51:702–708
Turmel-Rodrigues L, Pengloan J, Bourquelot P (2002) Interventional radiology in hemodialysis fistulae and grafts: a multidisciplinary approach. Cardiovasc Interv Radiol 25:3–16
Planken RN, Tordoir JH, Duijim LE, de Haam WM, Leiner T (2007) Current techniques for assessment of upper extremity vasculature prior to hemodialysis vascular access creation. Eur Radiol 17:3001–3011
Beathard GA (2009) Fistula salvage by endovascular therapy. Adv Chronic Kidney Dis 16:339–351
Goldstein SL, Allsteadt A, Smith C, Currier H (2002) Proactive monitoring hemodialysis vascular access: effects of ultrasound dilution on thrombosis rates. Kidney Int 62:272–275
Chand DH, Poe SA, Strife CF (2002) Venous pressure monitoring does not accurately predict access failure in children. Pediatr Nephrol 17:765–769
Chand D, Bednarz D, Eagleton M, Krajewski L (2009) A vascular access team can increase AV Fistula creation in pediatric ESRD patients: a single center experience. Semin Dial 22:679–683
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Briones, L., Diaz Moreno, A., Sierre, S. et al. Permanent vascular access survival in children on long-term chronic hemodialysis. Pediatr Nephrol 25, 1731–1738 (2010). https://doi.org/10.1007/s00467-010-1553-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-010-1553-7