Ali Mirza Onder1, Joseph T Flynn2, Anthony A Billings3, Fang Deng4, Marissa DeFreitas5, Chryso Katsoufis5, Matthew M Grinsell6, Larry T Patterson7, Jennifer Jetton8, Sahar Fathallah-Shaykh9, Daniel Ranch10, Diego Aviles11, Lawrence Copelovitch12, Eileen Ellis13, Vimal Chanda14, Ayah Elmaghrabi15, Jen-Jar Lin16, Lavjay Butani17, Maha Haddad17, Olivera Marsenic Couloures18, Paul Brakeman19, Raymond Quigley15, H Stella Shin20, Rouba Garro20, Hui Liu21, Javad Rahimikollu3, Rupesh Raina22, Craig B Langman4, Ellen G Wood23. 1. Division of Pediatric Nephrology, Le Bonheur Children's Hospital, University of Tennessee, School of Medicine, 49 N Dunlop Street, Faculty Office Building, Room 322, Memphis, TN, 38105, USA. aonder@uthsc.edu. 2. Division of Nephrology, Seattle Children's Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. 3. Department of Statistics, West Virginia University, Morgantown, WV, USA. 4. Kidney Diseases Division, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA. 5. Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children's Hospital, University of Miami Leonard M Miller School of Medicine, Miami, FL, USA. 6. Division of Pediatric Nephrology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA. 7. Division of Pediatric Nephrology, Children's National Health System, Washington, DC, USA. 8. Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA. 9. Division of Pediatric Nephrology, Children's of Alabama, University of Alabama, Birmingham, AL, USA. 10. Division of Pediatric Nephrology, University of Texas Health Science Center, San Antonio, TX, USA. 11. Division of Pediatric Nephrology, Children's Hospital New Orleans, LSU Heath School of Medicine, New Orleans, LA, USA. 12. Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 13. Division of Pediatric Nephrology, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. 14. Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA. 15. Division of Pediatric Nephrology, Children's Medical Center Dallas, UT Southwestern, Dallas, TX, USA. 16. Division of Pediatric Nephrology, Brenner Children's Hospital, Wake Forest University, Winston Salem, NC, USA. 17. Division of Pediatric Nephrology, UC Davis Children's Hospital, Sacramento, CA, USA. 18. Division of Pediatric Nephrology, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, 06504, USA. 19. Division of Pediatric Nephrology, UCSF Benioff Children's Hospital, San Francisco, CA, USA. 20. Division of Pediatric Nephrology, Children's Healthcare of Atlanta, Atlanta, GA, USA. 21. Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA. 22. Division of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, USA. 23. Department of Pediatrics, Division of Pediatric Nephrology, SSM Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA.
Abstract
BACKGROUND: Hemodialysis (HD) guidelines recommend permanent vascular access (PVA) in children unlikely to receive kidney transplant within 1 year of starting HD. We aimed to determine predictors of primary and secondary patency of PVA in pediatric HD patients. METHODS: Retrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome. RESULTS: There were 103 arterio-venous fistulae (AVF) and 14 AV grafts (AVG). AVF demonstrated superior primary (p = 0.0391) and secondary patency (p = 0.0227) compared to AVG. Primary failure occurred in 16 PVA (13.6%) and secondary failure in 14 PVA (12.2%). AVF were more likely to have primary failure (odds ratio (OR) = 2.10) and AVG had more secondary failure (OR = 3.33). No demographic, clinical, or laboratory variable predicted primary failure of PVA. Anatomical location of PVA was predictive of secondary failure, with radial having the lowest risk compared to brachial (OR = 12.425) or femoral PVA (OR = 118.618). Intervention-free survival was predictive of secondary patency for all PVA (p = 0.0252) and directly correlated with overall survival of AVF (p = 0.0197) but not AVG. Study center demonstrated statistically significant effect only on intervention-free AVF survival (p = 0.0082), but not number of complications or interventions, or outcomes. CONCLUSIONS: In this multi-center pediatric HD cohort, AVF demonstrated primary and secondary patency advantages over AVG. Radial PVA was least likely to develop secondary failure. Intervention-free survival was the only predictor of secondary patency for AVF and directly correlated with overall access survival. The study center effect on intervention-free survival of AVF deserves further investigation.
BACKGROUND: Hemodialysis (HD) guidelines recommend permanent vascular access (PVA) in children unlikely to receive kidney transplant within 1 year of starting HD. We aimed to determine predictors of primary and secondary patency of PVA in pediatric HDpatients. METHODS: Retrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome. RESULTS: There were 103 arterio-venous fistulae (AVF) and 14 AV grafts (AVG). AVF demonstrated superior primary (p = 0.0391) and secondary patency (p = 0.0227) compared to AVG. Primary failure occurred in 16 PVA (13.6%) and secondary failure in 14 PVA (12.2%). AVF were more likely to have primary failure (odds ratio (OR) = 2.10) and AVG had more secondary failure (OR = 3.33). No demographic, clinical, or laboratory variable predicted primary failure of PVA. Anatomical location of PVA was predictive of secondary failure, with radial having the lowest risk compared to brachial (OR = 12.425) or femoral PVA (OR = 118.618). Intervention-free survival was predictive of secondary patency for all PVA (p = 0.0252) and directly correlated with overall survival of AVF (p = 0.0197) but not AVG. Study center demonstrated statistically significant effect only on intervention-free AVF survival (p = 0.0082), but not number of complications or interventions, or outcomes. CONCLUSIONS: In this multi-center pediatric HD cohort, AVF demonstrated primary and secondary patency advantages over AVG. Radial PVA was least likely to develop secondary failure. Intervention-free survival was the only predictor of secondary patency for AVF and directly correlated with overall access survival. The study center effect on intervention-free survival of AVF deserves further investigation.
Authors: P Bagolan; A Spagnoli; G Ciprandi; S Picca; G Leozappa; A Nahom; A Trucchi; G Rizzoni; G Fabbrini Journal: J Vasc Surg Date: 1998-04 Impact factor: 4.268
Authors: Ian J Ramage; Alan Bailie; Kay S Tyerman; John H McColl; Stephen G Pollard; Maggie M Fitzpatrick Journal: Am J Kidney Dis Date: 2005-04 Impact factor: 8.860
Authors: P P G M Rooijens; J H M Tordoir; T Stijnen; J P J Burgmans; A A E A Smet de; T I Yo Journal: Eur J Vasc Endovasc Surg Date: 2004-12 Impact factor: 7.069
Authors: Benjamin K Dundon; Kim Torpey; Adam J Nelson; Dennis Tl Wong; Rae F Duncan; Ian T Meredith; Randall J Faull; Stephen G Worthley; Matthew I Worthley Journal: Int J Nephrol Renovasc Dis Date: 2014-09-16
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
Authors: Brittany Garza; Jessica Geer; Sarah J Swartz; Poyyapakkam Srivaths; Tam T T Huynh; Eileen D Brewer Journal: Pediatr Nephrol Date: 2022-05-05 Impact factor: 3.714