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Vascular access complications in long-term pediatric hemodialysis patients

Joshua J Zaritsky1, Isidro B Salusky, Barbara Gales

  • 1Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. jzaritsky@mednet.ucla.edu

Pediatric Nephrology (Berlin, Germany)
|August 21, 2008
PubMed

Insights

Pediatric hemodialysis (HD) patients using central venous catheters (CVCs) face higher complication rates and hospitalizations than those with arteriovenous grafts (AVGs) and fistulae (AVFs), despite similar quality of life.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Vascular Access

Background:

  • Pediatric patients on hemodialysis (HD) often utilize central venous catheters (CVCs).
  • Arteriovenous grafts (AVGs) and arteriovenous fistulae (AVFs) are alternative vascular access methods.

Purpose of the Study:

  • To compare complications and health-related quality of life (HRQOL) between CVCs and AVG/AVFs in pediatric HD patients.
  • To evaluate the long-term implications of vascular access choice for pediatric maintenance HD.

Main Methods:

  • Retrospective study at two large centers over one year.
  • Included pediatric patients (<25 years, >20 kg) on HD for ≥3 months.
  • Compared 30 CVC patients with 21 AVG/AVF patients.

Main Results:

  • CVC patients experienced significantly higher infectious complication rates (3.7 hospital days/100 HD treatments vs. 0.2 for AVG/AVF).
  • CVC patients required more access revisions (2.7 hospital days/100 HD treatments vs. 0.2 for AVG/AVF).
  • No significant difference in HRQOL was observed between CVC and AVG/AVF groups.

Conclusions:

  • Central venous catheters are associated with increased morbidity and complications in pediatric HD patients compared to AVGs/AVFs.
  • AVGs/AVFs should be prioritized as primary vascular access for pediatric patients requiring long-term maintenance HD.
  • Despite similar HRQOL, the higher complication rate necessitates a shift towards AVG/AVF use.

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