Ali Mirza Onder1,2, Joseph T Flynn3, Anthony A Billings4, Fang Deng5, Marissa DeFreitas6, Chryso Katsoufis6, Matthew M Grinsell7, Larry Patterson8, Jennifer Jetton9, Sahar Fathallah-Shaykh10, Daniel Ranch11, Diego Aviles12, Lawrence Copelovitch13, Eileen Ellis14, Vimal Chadha15, Ayah Elmaghrabi16, Jen-Jar Lin17, Lavjay Butani18, Maha Haddad18, Olivera Marsenic19, Paul Brakeman20, Raymond Quigley16, H Stella Shin21, Rouba Garro21, Hui Liu22, Javad Rahimikollu4, Rupesh Raina23, Craig B Langman5, Ellen Wood24. 1. Division of Pediatric Nephrology, Le Bonheur Children's Hospital, University of Tennessee, School of Medicine, Memphis, TN, USA. aonder1971@gmail.com. 2. Division of Pediatric Nephrology, Batson Children's Hospital of Mississippi , University of Mississippi Medical Center, Jackson, MS, USA. aonder1971@gmail.com. 3. Division of Nephrology, Seattle Children's Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. 4. Department of Statistics, West Virginia University, Morgantown, WV, USA. 5. Kidney Diseases Division, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA. 6. Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children's Hospital, University of Miami Leonard M Miller School of Medicine, Miami, FL, USA. 7. Division of Pediatric Nephrology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA. 8. Division of Pediatric Nephrology, Children's National Health System, Washington, DC, USA. 9. Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA. 10. Division of Pediatric Nephrology, Children's of Alabama, University of Alabama, Birmingham, AL, USA. 11. Division of Pediatric Nephrology, University of Texas Health Science Center, San Antonio, TX, USA. 12. Division of Pediatric Nephrology, Children's Hospital New Orleans, LSU Heath School of Medicine, New Orleans, LA, USA. 13. Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 14. Division of Pediatric Nephrology, Arkansas Children's Hospital, Little Rock, AR, 72202, USA. 15. Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA. 16. Division of Pediatric Nephrology, Children's Medical Center Dallas, UT Southwestern, Dallas, TX, USA. 17. Division of Pediatric Nephrology, Brenner Children's Hospital, Wake Forest University, Winston Salem, NC, USA. 18. Division of Pediatric Nephrology, UC Davis Children's Hospital, Sacramento, CA, USA. 19. Division of Pediatric Nephrology, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, 06504, USA. 20. Division of Pediatric Nephrology, UCSF Benioff Children's Hospital, San Francisco, CA, USA. 21. Division of Pediatric Nephrology, Children's Healthcare of Atlanta, Atlanta, GA, USA. 22. Division of General Academic Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA. 23. Division of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, USA. 24. Department of Pediatrics, Division of Pediatric Nephrology, SSM Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA.
Abstract
BACKGROUND: Permanent vascular access (PVA) is preferred for long-term hemodialysis. Arteriovenous fistulae (AVF) have the best patency and the lowest complication rates compared to arteriovenous grafts (AVG) and tunneled cuffed catheters (TCC). However, AVF need time to mature. This study aimed to investigate predictors of time to first cannulation for AVF in pediatric hemodialysis patients. METHODS: Data on first AVF and AVG of patients at 20 pediatric dialysis centers were collected retrospectively, including demographics, clinical information, dialysis markers, and surgical data. Statistical modeling was used to investigate predictors of outcome. RESULTS: First PVA was created in 117 children: 103 (88%) AVF and 14 (12%) AVG. Mean age at AVF creation was 15.0 ± 3.3 years. AVF successfully matured in 89 children (86.4%), and mean time to first cannulation was 3.6 ± 2.5 months. In a multivariable regression model, study center, age, duration of non-permanent vascular access (NPVA), and Kt/V at AVF creation predicted time to first cannulation, with study center as the strongest predictor (p < 0.01). Time to first cannulation decreased with increasing age (p = 0.03) and with increasing Kt/V (p = 0.01), and increased with duration of NPVA (p = 0.03). Secondary failure occurred in 10 AVF (11.8%). Time to first cannulation did not predict secondary failure (p = 0.29), but longer time to first cannulation tended towards longer secondary patency (p = 0.06). CONCLUSIONS: Study center is the strongest predictor of time to first cannulation for AVF and deserves further investigation. Time to first cannulation is significantly shorter in older children, with more efficient dialysis treatments, and increases with longer NPVA duration.
BACKGROUND: Permanent vascular access (PVA) is preferred for long-term hemodialysis. Arteriovenous fistulae (AVF) have the best patency and the lowest complication rates compared to arteriovenous grafts (AVG) and tunneled cuffed catheters (TCC). However, AVF need time to mature. This study aimed to investigate predictors of time to first cannulation for AVF in pediatric hemodialysispatients. METHODS: Data on first AVF and AVG of patients at 20 pediatric dialysis centers were collected retrospectively, including demographics, clinical information, dialysis markers, and surgical data. Statistical modeling was used to investigate predictors of outcome. RESULTS: First PVA was created in 117 children: 103 (88%) AVF and 14 (12%) AVG. Mean age at AVF creation was 15.0 ± 3.3 years. AVF successfully matured in 89 children (86.4%), and mean time to first cannulation was 3.6 ± 2.5 months. In a multivariable regression model, study center, age, duration of non-permanent vascular access (NPVA), and Kt/V at AVF creation predicted time to first cannulation, with study center as the strongest predictor (p < 0.01). Time to first cannulation decreased with increasing age (p = 0.03) and with increasing Kt/V (p = 0.01), and increased with duration of NPVA (p = 0.03). Secondary failure occurred in 10 AVF (11.8%). Time to first cannulation did not predict secondary failure (p = 0.29), but longer time to first cannulation tended towards longer secondary patency (p = 0.06). CONCLUSIONS: Study center is the strongest predictor of time to first cannulation for AVF and deserves further investigation. Time to first cannulation is significantly shorter in older children, with more efficient dialysis treatments, and increases with longer NPVA duration.
Entities:
Keywords:
Arteriovenous fistula; Arteriovenous graft; Hemodialysis; Maturation time; Pediatric; Time to first cannulation
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