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Reducing central venous catheters in chronic hemodialysis—a commitment to arteriovenous fistula creation in children

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Abstract

Background

An internal permanent vascular access [arteriovenous fistula (AVF) or arteriovenous graft (AVG)] is preferred over central venous catheters (CVC) for chronic hemodialysis. However, CVC remain the most commonly used access in children. The objective of this study was to evaluate our experience with AVF.

Methods

We conducted a retrospective chart review of children aged 1–18 years on chronic hemodialysis from 2001 to 2012. Patients were divided into three time periods: 2001–2005, 2006–2009 and 2010–2012. A systematic approach to AVF placement was introduced in our department in 2006 which resulted in a greater number of AVF being placed and used, but the access failure rate was still higher than desired. In 2010, a more experienced vascular surgeon was contacted to perform AVF surgery in our most difficult AVF candidates.

Results

Sixty-five AVF were created in 55 patients (67.3 % male). The median age of the patients was 14 (3–18) years. Forty-one (63.1 %) AVF were used successfully, and this number increased from 52.6 to 57.6 to 92.3 % over the three time periods, respectively. Over time, AVF use rates increased and CVC use decreased. By 2012 only 7.7 % of our patients were using a CVC. The primary patency rate was 42.9 % at 1 year; secondary patency rates were 100 and 93.8 % at 1 and 2 years, respectively. Infection and hospitalization rates were higher for CVC than for AVF [0.8 vs. 0.1 infections per access-year (p < 0.001) and 0.9 vs. 0.2 hospitalizations per access-year (p < 0.001)].

Conclusions

With a dedicated approach and vascular access team it is possible to decrease CVC and increase AVF use in children on hemodialysis. In our study, increased AVF use resulted in decreased access-related infection and hospitalization rates.

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Acknowledgments

We would like to thank Dr. Marc Webb for his surgical expertise and dedication; and to our hemodialysis staff for their commitment to excellence in clinical care to our patients.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, Children’s Hospital of Michigan/Wayne State University, 3901 Beaubien St, Detroit, MI, 48201, USA

    Rossana Baracco, Tej Mattoo, Amrish Jain, Gaurav Kapur & Rudolph P. Valentini

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  1. Rossana Baracco
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  2. Tej Mattoo
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  3. Amrish Jain
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  4. Gaurav Kapur
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  5. Rudolph P. Valentini
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Correspondence to Rudolph P. Valentini.

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Baracco, R., Mattoo, T., Jain, A. et al. Reducing central venous catheters in chronic hemodialysis—a commitment to arteriovenous fistula creation in children. Pediatr Nephrol 29, 2013–2020 (2014). https://doi.org/10.1007/s00467-013-2744-9

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  • DOI: https://doi.org/10.1007/s00467-013-2744-9

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