Skip to main content

Advertisement

SpringerLink
Log in

Vascular access for chronic hemodialysis in children: arteriovenous fistula or central venous catheter?

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

The choice of vascular access (VA) for hemodialysis (HD) in end-stage renal disease (ESRD) is arteriovenous fistula (AVF) or central venous catheter (CVC). Whereas clinical practice guidelines suggest AVF to preserve the vascular bed, pediatric nephrologists tend to favor CVC for shorter-term dialysis. Our objective was to determine whether pediatric priority allocation policies for deceased-donor kidneys affect VA planning.

Methods

Pediatric priority for deceased-donor kidneys was instituted in Quebec in 2004. We retrospectively compared clinical practice on AVF, CVC, wait time on transplant list, HD duration in pre-policy (group A) and post-policy (group B) from 1997–2011.

Results

We identified 78 patients with a median age of 14.7 years (range, 0.7–20.5 years) and weight of 46 kg (12.5–95 kg); AVF decreased from 76 % in group A to 41 % in group B (p = 0.002). Wait times on transplant list were significantly reduced: median 413.5 days (range, 2–1,910 days) in group A vs. 89 days (range, 18–692 days) in group B (p = 0.003). Time on HD for deceased-donor recipients was shorter: 705 (range, 51–1,965 days) group A vs. 349.5 days (range, 158–1,060 days) group B (p = 0.01).

Conclusions

This is the first study to document VA changes related to pediatric priority allocation policy. Our fistula-first center saw a shift toward CVC-first.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kim KVHB (2011) Pediatric kidney transplantation. In: Andrew A, Klein CJL, Madsen JC (eds) Organ transplantation a clinical guide. Cambridge University Press, Cambridge, pp 278–285

    Google Scholar 

  2. Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Herzog C, Ishani A, Johansen K, Kasiske B, Kutner N, Liu J, St Peter W, Ding S, Guo H, Kats A, Lamb K, Li S, Li S, Roberts T, Skeans M, Snyder J, Solid C, Thompson B, Weinhandl E, Xiong H, Yusuf A, Zaun D, Arko C, Chen SC, Daniels F, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L (2013) US renal data system 2012 annual data report. Am J Kidney Dis 61:A7, e1-476

    Article  PubMed  Google Scholar 

  3. Alexander SR, Sullivan EK, Harmon WE, Stablein DM, Tejani A (1993) Maintenance dialysis in North American children and adolescents: a preliminary report. north american pediatric renal transplant cooperative study (NAPRTCS). Kidney Int Suppl 43:S104–109

    PubMed  CAS  Google Scholar 

  4. Fadrowski JJ, Hwang W, Frankenfield DL, Fivush BA, Neu AM, Furth SL (2006) Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the clinical performance measures and US renal data system projects. Clin J Am Soc Nephrol 1:987–992

    Article  PubMed  Google Scholar 

  5. Bourquelot P (2009) Vascular access for haemodialysis. Nephrol Ther 5:239–248

    Article  PubMed  Google Scholar 

  6. Chand DH, Valentini RP, Kamil ES (2009) Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners. Pediatr Nephrol 24:1121–1128

    Article  PubMed  PubMed Central  Google Scholar 

  7. Warady BA, Neu AM, Schaefer F (2014) Optimal care of the infant, child, and adolescent on dialysis: 2014 Update. Am J Kidney Dis. doi:10.1053/j.ajkd.2014.01.430

    PubMed  Google Scholar 

  8. Mak RH, Warady BA (2013) Dialysis: vascular access in children–arteriovenous fistula or CVC? Nat Rev Nephrol 9:9–11

    Article  PubMed  Google Scholar 

  9. Zaritsky JJ, Salusky IB, Gales B, Ramos G, Atkinson J, Allsteadt A, Brandt ML, Goldstein SL (2008) Vascular access complications in long-term pediatric hemodialysis patients. Pediatr Nephrol 23:2061–2065

    Article  PubMed  Google Scholar 

  10. (1997) NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis 30:S150-191

  11. Chand DH, Valentini RP (2008) International pediatric fistula first initiative: a call to action. Am J Kidney Dis 51:1016–1024

    Article  PubMed  Google Scholar 

  12. Ma A, Shroff R, Hothi D, Lopez MM, Veligratli F, Calder F, Rees L (2013) A comparison of arteriovenous fistulas and central venous lines for long-term chronic haemodialysis. Pediatr Nephrol 28:321–326

    Article  PubMed  Google Scholar 

  13. Nguyen S, Martz K, Stablein D, Neu A (2011) Wait list status of pediatric dialysis patients in North America. Pediatr Transplant 15:376–383

    Article  PubMed  Google Scholar 

  14. Robitaille P, Mongeau JG, Yazbeck S, Bensoussan A, O'Regan S (1982) Renal grafts in pediatrics: follow up studies at St. Justine's Hospital since 1974. Union Med Can 111:810–817

    PubMed  CAS  Google Scholar 

  15. Abderrahmane M, Desmarais D, Robitaille P, Phan V, Clermont MJ, Lapeyraque AL, Merouani A (2009) A specialized and integrated outpatient clinic for the care of children with chronic kidney disease: experience of CHU Sainte-Justine. Nephrol Ther 5:631–636

    Article  PubMed  Google Scholar 

  16. Fehrman-Ekholm I, Lennerling A, Kvarnstrom N, Rizell M, Olausson M (2011) Living donor kidney transplantation–a successful story. very cost-effective–and the donors live long with good health. Lakartidningen 108:2492–2495

    PubMed  Google Scholar 

  17. Van Arendonk KJ, Garonzik Wang JM, Deshpande NA, James NT, Smith JM, Montgomery RA, Colombani PM, Segev DL (2013) Practice patterns and outcomes in retransplantation among pediatric kidney transplant recipients. Transplantation 95:1360–1368

    Article  PubMed  PubMed Central  Google Scholar 

  18. Smith JM, Martz K, Blydt-Hansen TD (2013) Pediatric kidney transplant practice patterns and outcome benchmarks, 1987–2010: a report of the North American pediatric renal trials and collaborative studies. Pediatr Transplant 17:149–157

    Article  PubMed  Google Scholar 

  19. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ (2012) Epidemiology of chronic kidney disease in children. Pediatr Nephrol 27:363–373

    Article  PubMed  PubMed Central  Google Scholar 

  20. Canadian Institute for Health Information (2012) Canadian Organ Replacement Register Annual Report: Treatment Of End-Stage Organ Failure in Canada, 2002 to 2011. CIHI, Ottawa, ON. Available at: https://secure.cihi.ca/free_products/2013_CORR_Annua_Report_EN.pdf

  21. North American pediatric renal trials and collaborative studies (2012) NAPRTCS 2011 Annual Dialysis Report. The EMMES Corporation. available at: http://www.emmes.com/study/ped/annlrept/annualrept2011.pdf

  22. 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

    Article  PubMed  PubMed Central  Google Scholar 

  23. Harambat J, van Stralen KJ, Schaefer F, Grenda R, Jankauskiene A, Kostic M, Macher MA, Maxwell H, Puretic Z, Raes A, Rubik J, Sorensen SS, Toots U, Topaloglu R, Tonshoff B, Verrina E, Jager KJ (2013) Disparities in policies, practices and rates of pediatric kidney transplantation in Europe. Am J Transplant 13:2066–2074

    Article  PubMed  CAS  Google Scholar 

  24. Agarwal S, Oak N, Siddique J, Harland RC, Abbo ED (2009) Changes in pediatric renal transplantation after implementation of the revised deceased donor kidney allocation policy. Am J Transplant 9:1237–1242

    Article  PubMed  CAS  Google Scholar 

  25. Loirat C, Chalem Y, Golmard JL (2001) Organ allocation in pediatric transplantation in France. Pediatr Nephrol 16:964–970

    Article  PubMed  CAS  Google Scholar 

  26. Mayer G, Persijn GG (2006) Eurotransplant kidney allocation system (ETKAS): rationale and implementation. Nephrol Dial Transplant 21:2–3

    Article  PubMed  Google Scholar 

  27. Smith JM, Stablein DM, Munoz R, Hebert D, McDonald RA (2007) Contributions of the transplant registry: the 2006 annual report of the North American pediatric renal trials and collaborative studies (NAPRTCS). Pediatr Transplant 11:366–373

    Article  PubMed  Google Scholar 

  28. Matas AJ, Smith JM, Skeans MA, Lamb KE, Gustafson SK, Samana CJ, Stewart DE, Snyder JJ, Israni AK, Kasiske BL (2013) OPTN/SRTR 2011 annual data report: kidney. Am J Transplant 13(Suppl 1):11–46

    Article  PubMed  Google Scholar 

  29. Cecka JM, Terasaki PI (1995) The UNOS scientific renal transplant registry. united network for organ sharing. Clin Transpl 1995:1–18

  30. Crafter SR, Bell L, Foster BJ (2007) Balancing organ quality, HLA-matching, and waiting times: impact of a pediatric priority allocation policy for deceased donor kidneys in Quebec. Transplantation 83:1411–1415

    Article  PubMed  Google Scholar 

  31. Bourquelot P, Wolfeler L, Lamy L (1981) Microsurgery for haemodialysis distal arteriovenous fistulae in children weighing less than 10 kg. Proc Eur Dial Transplant Assoc 18:537–541

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to thank the nurses of the CHU Sainte-Justine Dialysis and Transplant Unit. The authors are also grateful to Danielle Buch writer/editor at the Applied Clinical Research Unit of the CHU Sainte-Justine Research Center for revision and editing of the manuscript and Thierry Ducruet, for statistical expertise.

Support and financial disclosure declaration

The authors declare that they have no relevant financial interests.

Author information

Authors and Affiliations

  1. Pediatric Nephrology, Dialysis Unit, Department of Pediatrics, Sainte Justine Hospital (CHU Sainte-Justine), University of Montreal, 3175 Côte Sainte Catherine, Montreal, QC, H3T 1C5, Canada

    Aicha Merouani, Julie Paquet, Johanne Gagnon & Anne Laure Lapeyraque

  2. Pediatric Surgery, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada

    Michel Lallier

Authors
  1. Aicha Merouani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Lallier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie Paquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johanne Gagnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Laure Lapeyraque
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aicha Merouani.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merouani, A., Lallier, M., Paquet, J. et al. Vascular access for chronic hemodialysis in children: arteriovenous fistula or central venous catheter?. Pediatr Nephrol 29, 2395–2401 (2014). https://doi.org/10.1007/s00467-014-2877-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-014-2877-5

Keywords

Search

Navigation