Dagmara Borzych-Duzalka1, Rukshana Shroff2, Gema Ariceta3, Yok-Chin Yap4, Fabio Paglialonga5, Hong Xu6, Hee Gyung Kang7, Julia Thumfart8, Karabay Bayazit Aysun9, Constantinos J Stefanidis10, Marc Fila11, Lale Sever12, Karel Vondrak13, Attila J Szabo14, Maria Szczepanska15, Bruno Ranchin16, Tuula Holtta17, Ariane Zaloszyc18, Ilmay Bilge19, Bradley A Warady20, Franz Schaefer21, Claus Peter Schmitt22. 1. Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland. 2. Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 3. Hospital Universitario Materno-Infantil Vall D Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. 4. Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. 5. Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda, Osp. Maggiore Policlinico, Milano, Italy. 6. Fundan University, Shanghai, China. 7. Kidney Center for Children and Adolescents, Seoul, Korea. 8. Charité, Virchow Klinikum, Berlin, Germany. 9. Department of Pediatric Nephrology, Cukurova University, Faculty of Medicine, Adana, Turkey. 10. Mitera Children's Hospital, Athens, Greece. 11. Pediatric Nephrology Unit, CHU Arnaud de Villeneuve-Université de Montpellier, Montpellier, France. 12. Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey. 13. University Hospital Motol, Prague, Czech Republic. 14. MTA-SE Pediatric and Nephrology Research Group, Budapest, Hungary. 15. Department of Pediatrics, SMDZ in Zabrze, SUM in Katowice, Poland. 16. Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France. 17. Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. 18. Children's Dialysis Center, Strasbourg, France. 19. Istanbul University Medical Faculty; Koc University, School of Medicine, Istanbul, Turkey. 20. Children's Mercy Hospital, Kansas City, KS. 21. Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany. 22. Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany. Electronic address: claus.peter.schmitt@med.uni-heidelberg.de.
Abstract
RATIONALE & OBJECTIVE: Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS: Clinical rather than population-based data. CONCLUSIONS: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.
RATIONALE & OBJECTIVE:Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS: Clinical rather than population-based data. CONCLUSIONS: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.
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