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Vascular access survival in children and young adults receiving long-term hemodialysis

Ian J Ramage1, Alan Bailie, Kay S Tyerman

  • 1Renal Unit, Royal Hospital for Sick Children, Glasgow, Scotland. ian.ramage@yorkhill.scot.nhs.uk

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|April 5, 2005
PubMed

Insights

For pediatric hemodialysis, arteriovenous fistulae (AVFs) demonstrate superior survival rates compared to cuffed central venous catheters (CVLs). Experienced operators and patient factors significantly influence vascular access outcomes in children requiring long-term dialysis.

Area of Science:

  • Pediatric Nephrology
  • Vascular Surgery
  • Dialysis Access Management

Background:

  • Long-term hemodialysis in children presents unique challenges due to smaller vessels and lifelong access needs.
  • Cuffed central venous catheters (CVLs) are increasingly used over arteriovenous fistulae (AVFs) and arteriovenous grafts (AVGs).

Purpose of the Study:

  • To compare the survival rates of CVLs, AVFs, and AVGs in pediatric patients undergoing long-term hemodialysis.
  • To identify factors influencing the survival of vascular access in this population.

Main Methods:

  • A 20-year retrospective study of pediatric patients receiving long-term hemodialysis.
  • Data collected included patient demographics, clinical factors, access type/site, and operator experience.
  • Survival analysis was performed for different vascular access types.

Main Results:

  • Arteriovenous fistulae (AVFs) showed significantly longer median censored survival (3.14 years) compared to CVLs (0.6 years).
  • Younger age, less experienced operators, hypoalbuminemia, and access type (AVF better than CVL) were associated with poorer vascular access survival.
  • AVFs were favored over CVLs, with limited use of AVGs.

Conclusions:

  • Arteriovenous fistulae offer improved survival outcomes compared to central venous catheters and grafts in pediatric hemodialysis.
  • Vascular access in pediatric patients requires careful consideration of operator expertise and patient-specific factors to ensure long-term dialysis accessibility.
Abstract

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