Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners

Area of Science:

• Nephrology
• Pediatric Medicine
• Vascular Surgery

Background:

• Pediatric end-stage renal disease (ESRD) incidence and prevalence have significantly increased over the last two decades.
• Hemodialysis (HD) is the predominant renal replacement therapy for children, surpassing peritoneal dialysis and transplantation.
• Central venous catheters are the primary vascular access for pediatric HD patients in the USA, despite adult 'fistula first' initiatives.

Purpose of the Study:

• To review various pediatric vascular access types used globally for hemodialysis.
• To discuss the benefits and drawbacks associated with different vascular access modalities in children.
• To emphasize the importance of strategic planning and multidisciplinary collaboration in pediatric vascular access management.

Main Methods:

• Literature review of global pediatric vascular access options for hemodialysis.
• Analysis of current trends in pediatric hemodialysis access in the United States.
• Discussion of best practices for vascular access planning, placement, and management.

Main Results:

• Hemodialysis is the most common treatment for pediatric ESRD.
• Central venous catheters are widely used for pediatric hemodialysis access.
• Effective vascular access management necessitates advance planning, team communication, and ongoing monitoring.

Conclusions:

• Optimizing vascular access is crucial for minimizing morbidity in pediatric hemodialysis patients.
• A long-term vision and coordinated multidisciplinary approach are essential for successful pediatric vascular access.
• Further research and discussion on the benefits and disadvantages of various pediatric vascular access types are warranted.