Factors Influencing Early Primary Patency of Av Fistula in Pediatric Patients With Chronic Kidney Disease.

Abstract

Background: Arteriovenous fistulae (AVF) are the dialysis access modality of choice for patients with end stage renal disease (ESRD). The longer maturation time in children than that in adults and the technical difficulties imposed by small diameters of the vessels are other reasons for a reluctance to create AVFs in children. Methods: Data abstracted included age, weight, sex, etiology of renal failure, time on dialysis, CVC history, and transplantation history. Patients of age 0 to 15 were included in this study, age was the only inclusion criteria. Results: Pre operative and prior vene puncture was present in (80%) patients with primary failure. Greater than 1 previous access failure strong predictor of failure. Surprisingly absence of prior HD was favoring early failure. Intraoperatively poor vein distension( <2mm) and post operative Doppler showing absence of spiral laminar flow also predicted early failure in 100% of the patients. Conclusion: anatomic factors like vein distension, prior venepuncture highly influence the patency rates. anemia, hypertension and HD benefitted in maintaining patency. proper education of the medical fraternity dealing with peadiatric renal failure patients regarding these factor will help in long term functioning of the fistulas and survival.