BACKGROUND: Transplantation is the optimal therapy for pediatric end-stage renal disease (ESRD) patients, but in a subset of patients with peritoneal membrane failure, failed transplants or poor social situations, chronic hemodialysis (HD) remains the only option. Long-term survival of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in pediatric patients has not been well described. METHODS: We studied the survival of permanent vascular access in 34 pediatric ESRD patients treated with chronic HD at our institution between 1/1/89 and 12/1/95 and followed to 12/31/2000. RESULTS: Twenty-four AVFs and 28 AVGs were created in 19 and 23 patients, respectively. Mean age and weight at insertion were 15.1 years (range 7.1 to 20.9) and 46 kg (18 to 81) for AVFs and 13.3 years (3.8 to 21.1) and 41.5 kg (10.5 to 145) for AVGs. Fifteen patients weighed <35 kg at the time of access creation (7 AVFs in 5 patients, 14 AVGs in 13 patients). Excluding primary failures, one-year, three-year and five-year patency rates for AVFs (74%, 59%, 59%) and AVGs (96%, 69%, 40%) were not significantly different. Patency did not correlate with patient weight or age at access creation. Primary access failure occurred more often (P < 0.01) in AVFs (8/24) compared to AVGs (1/28). Access thrombosis, stenosis and infection occurred more frequently in AVG (P = 0.02). CONCLUSIONS: Both AVF and AVG function well even in small pediatric patients and have survival rates equivalent to adult series and longer than cuffed venous catheters in pediatric patients. Both AVFs and AVGs are preferable for long-term HD access in pediatrics.
BACKGROUND: Transplantation is the optimal therapy for pediatric end-stage renal disease (ESRD) patients, but in a subset of patients with peritoneal membrane failure, failed transplants or poor social situations, chronic hemodialysis (HD) remains the only option. Long-term survival of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in pediatric patients has not been well described. METHODS: We studied the survival of permanent vascular access in 34 pediatric ESRDpatients treated with chronic HD at our institution between 1/1/89 and 12/1/95 and followed to 12/31/2000. RESULTS: Twenty-four AVFs and 28 AVGs were created in 19 and 23 patients, respectively. Mean age and weight at insertion were 15.1 years (range 7.1 to 20.9) and 46 kg (18 to 81) for AVFs and 13.3 years (3.8 to 21.1) and 41.5 kg (10.5 to 145) for AVGs. Fifteen patients weighed <35 kg at the time of access creation (7 AVFs in 5 patients, 14 AVGs in 13 patients). Excluding primary failures, one-year, three-year and five-year patency rates for AVFs (74%, 59%, 59%) and AVGs (96%, 69%, 40%) were not significantly different. Patency did not correlate with patient weight or age at access creation. Primary access failure occurred more often (P < 0.01) in AVFs (8/24) compared to AVGs (1/28). Access thrombosis, stenosis and infection occurred more frequently in AVG (P = 0.02). CONCLUSIONS: Both AVF and AVG function well even in small pediatric patients and have survival rates equivalent to adult series and longer than cuffed venous catheters in pediatric patients. Both AVFs and AVGs are preferable for long-term HD access in pediatrics.
Authors: Paul Monagle; Anthony K C Chan; Neil A Goldenberg; Rebecca N Ichord; Janna M Journeycake; Ulrike Nowak-Göttl; Sara K Vesely Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: Jeffrey J Fadrowski; Wenke Hwang; Alicia M Neu; Barbara A Fivush; Susan L Furth Journal: Am J Kidney Dis Date: 2008-10-31 Impact factor: 8.860
Authors: Ali Mirza Onder; Joseph T Flynn; Anthony A Billings; Fang Deng; Marissa DeFreitas; Chryso Katsoufis; Matthew M Grinsell; Larry T Patterson; Jennifer Jetton; Sahar Fathallah-Shaykh; Daniel Ranch; Diego Aviles; Lawrence Copelovitch; Eileen Ellis; Vimal Chanda; Ayah Elmaghrabi; Jen-Jar Lin; Lavjay Butani; Maha Haddad; Olivera Marsenic Couloures; Paul Brakeman; Raymond Quigley; H Stella Shin; Rouba Garro; Hui Liu; Javad Rahimikollu; Rupesh Raina; Craig B Langman; Ellen G Wood Journal: Pediatr Nephrol Date: 2018-09-27 Impact factor: 3.714
Authors: Ali Mirza Onder; Joseph T Flynn; Anthony A Billings; Fang Deng; Marissa DeFreitas; Chryso Katsoufis; Matthew M Grinsell; Larry Patterson; Jennifer Jetton; Sahar Fathallah-Shaykh; Daniel Ranch; Diego Aviles; Lawrence Copelovitch; Eileen Ellis; Vimal Chadha; Ayah Elmaghrabi; Jen-Jar Lin; Lavjay Butani; Maha Haddad; Olivera Marsenic; Paul Brakeman; Raymond Quigley; H Stella Shin; Rouba Garro; Hui Liu; Javad Rahimikollu; Rupesh Raina; Craig B Langman; Ellen Wood Journal: Pediatr Nephrol Date: 2019-11-06 Impact factor: 3.714