Vascular access: choice and complications in European paediatric haemodialysis units

Hayes, Wesley; Watson, Alan R.; Callaghan, Nichola; Wright, Elizabeth C.; Stefanidis, Constantinos J.

doi:10.1007/s00467-011-2079-3

Cited by 69 publications

(38 citation statements)

References 31 publications

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“…An arteriovenous fistula (AVF) is generally considered to be the optimum access for HD in adults and, as suggested by an emerging body of evidence, also in children [2–4]. However, most children continue to have a cuffed central venous catheter (CVC) as the first choice for vascular access [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

A dedicated vascular access clinic for children on haemodialysis: Two years’ experience

et al. 2016

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BackgroundArteriovenous fistula (AVF) formation for long-term haemodialysis in children is a niche discipline with little data for guidance. We developed a dedicated Vascular Access Clinic that is run jointly by a transplant surgeon, paediatric nephrologist, dialysis nurse and a clinical vascular scientist specialised in vascular sonography for the assessment and surveillance of AVFs. We report the experience and 2-year outcomes of this clinic.MethodsTwelve new AVFs were formed and 11 existing AVFs were followed up for 2 years. All children were assessed by clinical and ultrasound examination.ResultsDuring the study period 12 brachiocephalic, nine basilic vein transpositions and two radiocephalic AVFs were followed up. The median age (interquartile range) and weight of those children undergoing new AVF creation were 9.4 (interquartile 3–17) years and 26.9 (14–67) kg, respectively. Pre-operative ultrasound vascular mapping showed maximum median vein and artery diameters of 3.0 (2–5) and 2.7 (2.0–5.3) mm, respectively. Maturation scans 6 weeks after AVF formation showed a median flow of 1277 (432–2880) ml/min. Primary maturation rate was 83 % (10/12). Assisted maturation was 100 %, with two patients requiring a single angioplasty. For the 11 children with an existing AVF the maximum median vein diameter was 14.0 (8.0–26.0) mm, and the median flow rate was 1781 (800–2971) ml/min at a median of 153 weeks after AVF formation. Twenty-two AVFs were used successfully for dialysis, a median kt/V of 1.97 (1.8–2.9), and urea reduction ratio of 80.7 % (79.3–86 %) was observed. One child was transplanted before the AVF was used.ConclusionsA multidisciplinary vascular clinic incorporating ultrasound assessment is key to maintaining young children on chronic haemodialysis via an AVF.

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Section: Introductionmentioning

confidence: 99%

A dedicated vascular access clinic for children on haemodialysis: Two years’ experience

et al. 2016

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“…The CVC, unlike AVF has a high prevalence of infection, high costs, and associated with increased morbidity and mortality (Combe et al, 2000; Hoen et al, 1995; Lee et al, 2002), Therefore, AVF is the recommended vascular conduit for HD by the Canadian and American kidney associations (Levin & Rocco, 2006). CVC is still continued to be used as a bridge of vascular access in most centers (Fadrowski, Hwang, Neu, Fivush, & Furth, 2009; Hayes et al, 2012). Since AVF needs time to mature to be used for HD, CVC are still being used for emergent HD in these patients (Levin & Rocco, 2006).…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Hemodialysis Adequacy in Cohort of Iranian Patient with End Stage Renal Disease

Shahdadi¹,

Balouchi²,

Sepehri³

et al. 2015

GJHS

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Background:There are many factors that can affect dialysis adequacy; such as the type of vascular access, filter type, device used, and the dose, and rout of erythropoietin stimulation agents (ESA) used. The aim of this study was investigating factors affecting Hemodialysis adequacy in cohort of Iranian patient with end stage renal disease (ESRD).Methods:This is a cross-sectional study conducted on 133 Hemodialysis patients referred to two dialysis units in Sistan-Baluchistan province in the cities of Zabol and Iranshahr, Iran. We have looked at, (the effects of the type of vascular access, the filter type, the device used, and the dose, route of delivery, and the type of ESA used) on Hemodialysis adequacy. Dialysis adequacy was calculated using kt/v formula, two-part information questionnaire including demographic data which also including access type, filter type, device used for hemodialysis (HD), type of Eprex injection, route of administration, blood groups and hemoglobin response to ESA were utilized. The data was analyzed using the SPSS v16 statistical software. Descriptive statistical methods, Mann-Whitney statistical test, and multiple regressions were used when applicable.Results:The range of calculated dialysis adequacy is 0.28 to 2.39 (units of adequacy of dialysis). 76.7% of patients are being dialyzed via AVF and 23.3% of patients used central venous catheters (CVC). There was no statistical significant difference between dialysis adequacy, vascular access type, device used for HD (Fresenius and B. Braun), and the filter used for HD (p> 0.05). However, a significant difference was observed between the adequacy of dialysis and Eprex injection and patients’ time of dialysis (p <0.05).Conclusion:Subcutaneous ESA (Eprex) injection and dialysis shift (being dialyzed in the morning) can have positive impact on dialysis adequacy. Patients should be educated on the facts that the type of device used for HD and the vascular access used has no significant effects on dialysis adequacy.

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“…All the caregivers were instructed for appropriate performance of the procedure emphasizing aseptic techniques and were managed by automated PD. For HD , an arteriovenous graft or fistula was used in 44 patients (all of whom weighed > 20 kg, 52%) [23] and a central venous perm-cuffed catheter (Permacath [26]) in 41 (48%). Noncuffed central catheters were only used when there was an acute indication for dialysis and used as a bridge until a permanent access could be secured.…”

Section: Resultsmentioning

confidence: 99%

“…Primary graft/arteriovenous fistulas are considered the best permanent vascular access for HD with lowest risks of secondary failure and complications [26]; they were used in 52% of our patients, a significantly higher rate than reported in the literature (36% and 21.3%) [22, 28]. The rate of infections was low in our study compared to NAPRTCS [20]: 2 episodes per 100 patient-years versus 8.1 per 100 patient-years.…”

Section: Discussionmentioning

confidence: 99%

Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

Erez

Krause

Dagan

et al. 2016

International Journal of Nephrology

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Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was 13.5 ± 5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90% for patients older than 5 years and 61% for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.

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Vascular access: choice and complications in European paediatric haemodialysis units

Cited by 69 publications

References 31 publications

A dedicated vascular access clinic for children on haemodialysis: Two years’ experience

A dedicated vascular access clinic for children on haemodialysis: Two years’ experience

Factors Affecting Hemodialysis Adequacy in Cohort of Iranian Patient with End Stage Renal Disease

Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

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