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Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children

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Abstract

Arteriovenous fistulas (AVFs) are widely used for haemodialysis (HD) in adults with stage 5 chronic kidney disease (CKD 5) and are generally considered the best form of vascular access (VA). The ‘Fistula First’ initiative in 2003 helped to change the culture of VA in adults. However, this cultural change has not yet been adopted in children despite the fact that a functioning AVF is associated with lower complication rates and longer access survival than a central venous line (CVL). For children with CKD 5, especially when kidney failure starts early in life, there is a risk that all VA options will be exhausted. Therefore, it is essential to develop long-term strategies for optimal VA creation and maintenance. Whilst AVFs are the preferred VA in the paediatric population on chronic HD, they may not be suitable for every child. Recent guidelines and observational data in the paediatric CKD 5 population recommend switching from a ‘Catheter First’ to ‘Catheter Last’ approach. In this review, recent evidence is summarized in order to promote change in current practices.

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Authors and Affiliations

  1. Southampton Children’s Hospital and University of Southampton School of Medicine, Tremona Road, Southampton, SO16 6YD, UK

    Evgenia Preka

  2. UCL Great Ormond Street Hospital for Children Institute of Child Health, London, UK

    Rukshana Shroff, Lynsey Stronach & Francis Calder

  3. Evelina London Children’s Hospital NHS Foundation Trust, London, UK

    Francis Calder

  4. “Mitera” Children’s Hospital, Maroussi, Athens, Greece

    Constantinos J. Stefanidis

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  1. Evgenia Preka
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Preka, E., Shroff, R., Stronach, L. et al. Update on the creation and maintenance of arteriovenous fistulas for haemodialysis in children. Pediatr Nephrol 36, 1739–1749 (2021). https://doi.org/10.1007/s00467-020-04746-6

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