International pediatric fistula first initiative: a call to action

Area of Science:

• Nephrology
• Vascular Surgery
• Pediatric Dialysis

Background:

• Centers for Medicare & Medicaid Services and National Kidney Foundation emphasize increased arteriovenous fistula (AVF) use and decreased central venous catheter use.
• Despite rising pediatric hemodialysis rates in the US, AVF use has declined over the past decade.
• AVFs in pediatric patients demonstrate superior dialysis delivery, enhanced access survival, and significantly lower infection rates compared to other access methods.

Purpose of the Study:

• To alert nephrologists to prioritize AVF creation in pediatric patients undergoing long-term hemodialysis.
• To highlight the critical need for specialized surgical expertise, including microsurgery, for pediatric AVF creation.
• To introduce the International Pediatric Fistula First Initiative and its goals.

Main Methods:

• Review of current vascular access status in pediatric hemodialysis patients globally and within the United States.
• Description of the importance and benefits of AVF creation in children.
• Introduction of a multidisciplinary team approach through the International Pediatric Fistula First Initiative.

Main Results:

• AVF use rates in pediatric hemodialysis patients have decreased over the last 10 years.
• Studies confirm AVFs offer superior dialysis delivery, improved access survival, and lower infection rates in children.
• The International Pediatric Fistula First Initiative is established to increase awareness and provide educational tools.

Conclusions:

• A "fistula first" approach is crucial for pediatric long-term hemodialysis patients.
• Increased AVF utilization in children can lead to better clinical outcomes and reduced complications.
• Multidisciplinary collaboration is essential for the successful implementation of the fistula first initiative in pediatric populations.