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Permanent vascular access survival in children on long-term chronic hemodialysis

Liliana Briones1, Alexia Diaz Moreno, Sergio Sierre

  • 1Department of Nephrology, Hemodialysis Unit, Hospital de Pediatría Prof JP Garrahan, Buenos Aires, Argentina. lmbriones@gmail.com

Pediatric Nephrology (Berlin, Germany)
|June 3, 2010
PubMed

Insights

Autogenous fistulas (AVFs) show better long-term outcomes than artificial grafts (AVGs) for pediatric hemodialysis vascular access. Regular monitoring and early intervention are crucial for managing complications and extending access survival in children undergoing chronic dialysis.

Area of Science:

  • Pediatric Nephrology
  • Vascular Surgery
  • Dialysis Access Management

Background:

  • Chronic hemodialysis (HD) in pediatric patients necessitates reliable permanent vascular access (VA).
  • Management and outcomes of VA in children with end-stage renal disease (ESRD) require careful consideration.

Purpose of the Study:

  • To report a single-center experience on the management and outcomes of permanent VA in pediatric patients on chronic HD.
  • To compare the survival and complication rates of arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in this population.

Main Methods:

  • Retrospective analysis of 137 permanent VA (89 AVFs, 48 AVGs) created in 79 pediatric ESRD patients from 2000-2008.
  • Evaluation of VA survival, patency rates (primary and secondary), and complication incidence.
  • Statistical comparison of AVF versus AVG outcomes based on patient weight and intervention rates.

Main Results:

  • AVF creation was more frequent in children >25 kg, while AVGs were more common in those <25 kg.
  • 1-year primary patency rates: 50% for AVF, 30% for AVG.
  • Higher rates of surgical/endovascular interventions, stenosis, thrombosis, and infection were observed with AVGs compared to AVFs.

Conclusions:

  • Autogenous fistulas (AVFs) demonstrate superior long-term outcomes compared to artificial grafts (AVGs) for pediatric hemodialysis vascular access.
  • Early detection and treatment of access complications through surveillance and radiologic procedures are essential for prolonging VA survival in children.

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