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Changes in vascular access profile for pediatric hemodialysis patients over time: A registry-based study from

Ramon Roca-Tey1, Gema Ariceta2,3, Héctor Ríos2

  • 1Department of Nephrology, Hospital Universitari Mollet, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain.

The Journal of Vascular Access
|October 11, 2023
PubMed

Insights

Vascular access choices for pediatric hemodialysis patients have shifted, with fewer starting dialysis and more receiving kidney transplants. The increasing kidney transplant rate significantly influences vascular access selection in Catalonia.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Vascular Access

Background:

  • Vascular access (VA) selection criteria for pediatric hemodialysis (HD) have evolved towards a patient-centered approach.
  • This study examines VA types used in pediatric end-stage kidney disease (ESKD) patients on HD in Catalonia.

Purpose of the Study:

  • To analyze trends in vascular access utilization for pediatric patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD).
  • To investigate the impact of changing treatment paradigms, such as increased kidney transplantation, on VA selection in pediatric HD patients.

Main Methods:

  • Retrospective analysis of the Catalan Renal Registry data for pediatric patients (<18 years) from 1997 to 2018.
  • Examined kidney replacement therapy (KRT) modalities and vascular access types (fistula, catheter) for incident and prevalent ESKD patients.

Main Results:

  • The proportion of children starting KRT with HD decreased, while preemptive kidney transplantation (KT) increased significantly.
  • Use of arteriovenous fistula (AVF) for initiating HD in children declined, with a rise in tunneled catheter use.
  • The prevalence of children on HD decreased, with a corresponding increase in functioning kidney grafts; KT rates rose substantially.

Conclusions:

  • The increasing kidney transplantation rate is a key factor influencing vascular access choices in pediatric HD patients.
  • Treatment strategies are shifting towards transplantation, impacting the types of vascular access required for pediatric end-stage kidney disease management.
Abstract

Keywords:
arteriovenous fistulacatheterhemodialysiskidney transplantationpediatric patientsvascular access

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