Vascular access in children on chronic hemodialysis: a Slovenian experience

Area of Science:

• Nephrology
• Vascular Surgery
• Pediatrics

Background:

• End-stage renal disease (ESRD) necessitates hemodialysis (HD) in children and adolescents.
• Vascular access is crucial for effective HD treatment in pediatric patients.
• Arteriovenous fistulas (AVFs) and central venous catheters (CVCs) are common vascular access modalities.

Purpose of the Study:

• To evaluate the experience with arteriovenous fistulas (AVFs) and non-cuffed central venous catheters (CVCs) in pediatric patients undergoing hemodialysis.
• To compare the efficacy and complication rates of AVFs and CVCs in children with end-stage renal disease.
• To determine the suitability of these vascular accesses for long-term hemodialysis in a pediatric population.

Main Methods:

• Retrospective study of pediatric patients (≤18 years) with ESRD on HD between December 1998 and December 2010.
• Data collection on the creation, use, and outcomes of 35 AVFs and 77 non-cuffed CVCs.
• Analysis of primary failure rates, maturation times, patency, and bacteremia incidence.

Main Results:

• AVFs had a primary failure rate of 25.7%, with a mean maturation time of 4.0 months and mean patency of 42.5 months.
• Non-cuffed CVCs, primarily inserted in the jugular vein with citrate locking, had a bacteremia incidence of 0.9 episodes per 1000 catheter days.
• CVCs were used for an average of 3.6 months.

Conclusions:

• Native AVFs are the preferred vascular access for pediatric hemodialysis.
• Non-cuffed, jugular vein CVCs with citrate locking can serve as acceptable long-term vascular access when AVFs are not possible.
• Careful consideration of vascular access type is essential for optimizing hemodialysis outcomes in children with ESRD.