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Vascular access complications in long-term pediatric hemodialysis patients

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Abstract

Current data demonstrate pediatric patients who remain on hemodialysis (HD) therapy are more likely to be dialyzed via central venous catheters (CVCs) than arteriovenous grafts (AVGs) and fistulae (AVFs). We retrospectively compared complications and health-related quality of life (HRQOL) associated with different vascular access types at two large centers over a 1-year period. Patients included in the study were younger than 25 years of age, weighed >20 kg, and had received HD for at least 3 months. Thirty CVC patients and 21 AVG/AVF patients received a total of 2,393 and 3,506 HD treatments, respectively. The infectious complication rate was higher for CVC patients, who were hospitalized 3.7 days for each 100 HD treatments versus 0.2 days for AVG/AVF patients (p < 0.01). CVC patients also had a much higher rate of access revision, needing 2.7 hospital days every 100 HD treatments compared with 0.2 days for AVG/AVF patients (p < 0.01). HRQOL scores did not differ between groups. Thus, despite similar HRQOL, CVCs were associated with more complications and greater morbidity when compared with AVG/AVFs. These findings further emphasize the need to use AVG/AVFs as primary HD access for pediatric patients expected to receive a long course of maintenance HD.

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Acknowledgments

This work was supported in part by USPHS grants DK-35423 and DK-67563 and funds from the Casey Lee Ball Foundation.

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Authors and Affiliations

  1. Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Joshua J. Zaritsky, Isidro B. Salusky, Barbara Gales & Georgina Ramos

  2. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    James Atkinson

  3. Renal Dialysis Unit, Texas Children’s Hospital, Houston, TX, USA

    Amelia Allsteadt

  4. Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, CA, USA

    Mary L. Brandt

  5. Department of Pediatrics-Renal Section, Baylor College of Medicine, Houston, CA, USA

    Stuart L. Goldstein

  6. A2-383 MDCC, 650 Charles Young Dr, Los Angeles, CA, 90095-1752, USA

    Joshua J. Zaritsky

Authors
  1. Joshua J. Zaritsky
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  2. Isidro B. Salusky
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  3. Barbara Gales
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  4. Georgina Ramos
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  5. James Atkinson
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  6. Amelia Allsteadt
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  7. Mary L. Brandt
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  8. Stuart L. Goldstein
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Correspondence to Joshua J. Zaritsky.

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Zaritsky, J.J., Salusky, I.B., Gales, B. et al. Vascular access complications in long-term pediatric hemodialysis patients. Pediatr Nephrol 23, 2061–2065 (2008). https://doi.org/10.1007/s00467-008-0956-1

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  • DOI: https://doi.org/10.1007/s00467-008-0956-1

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