Permanent vascular access survival in children on long-term chronic hemodialysis

Abstract

The aim of this study is to report a single-center experience regarding the management and outcome of permanent vascular accesses (VA) in children on chronic hemodialysis (HD). We analyzed the survival of permanent VA in 79 pediatric patients with end-stage renal disease patients on chronic HD between January 2000 and December 2008. One hundred and thirty-seven VA [89 native fistulas (AVFs) and 48 grafts (AVGs)] were created in 79 children. The creation of AVFs was significantly more frequent in children weighing >25 kg and AVGs in children weighing <25 kg (p = 0.003). The 1-year primary patency rate was 50% for AVF and 30% for AVG. The secondary patency rates at 1, 2, and 3 years for AVFs were 73, 50, and 20% and for AVGs were 64, 36, and 20%, respectively. The total number of surgical and endovascular interventions was significantly higher in AVGs (p <or=0.05). Access stenosis, thrombosis and infection episodes occurred more frequently in AVG (p = 0.02). VAs had a high rate of interventions. Our study demonstrated better results of AVFs formation over AVGs, for long-term HD access in pediatrics. Surveillance and radiologic procedures are necessary for early detection and treatment of access complications in order to extend access survival.

Outcomes of Arteriovenous Fistula for Hemodialysis in Pediatric and Adolescent Patients

“…Although these documented outcomes are acceptable, some have considered the incidence of primary failure to be sufficiently high to be a barrier for AVF placement in children and adolescents [ 1 ]. 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 [ 11 ].…”

Pediatric Patients Undergoing Arteriovenous Fistula Surgery without Intraoperative Heparin

“…To the best of our knowledge none of the previously published data focused on effects of intraoperative systemic or local anticoagulation, whereas the reported outcome data are comparable to the results of our study (Tab. III) (4, 7, 12–15).…”

Vascular Access for Long-Term Hemodialysis/Hemodiafiltration Patients

“…In Japan, the ratio of long-term HD/HDF patients is higher than that in western countries, thus long-term stable VA maintenance is an important issue. Globally, patients on hemodialysis treatment for more than 30 years are rare, with the majority of those cases using an AVF (5). However, it is inevitable to change from AVF to AVG in cases with vascular deterioration due to long-term use.…”