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Vascular access challenges in hemodialysis children
Doaa M Salah1, Fatina I Fadel1, Mohamed A Abdel Mawla2
1Department of Pediatrics, Pediatric Nephrology and Transplantation Unit, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Italian Journal of Pediatrics
|January 23, 2024
Summary
Vascular access in pediatric hemodialysis often relies on non-cuffed central venous catheters due to vessel size limitations. Arteriovenous fistulas are preferred but challenging to create in children with end-stage kidney disease.
Area of Science:
- Pediatric Nephrology
- Vascular Access Surgery
- Renal Replacement Therapy
Background:
- Hemodialysis (HD) success in children with end-stage kidney disease (ESKD) is critically dependent on appropriate vascular access (VA).
- Pediatric Nephrology Unit (PNU) at Cairo University Children's Hospital (CUCH) has extensive experience with VA-related challenges in pediatric ESKD patients.
Purpose of the Study:
- To report the experience of a pediatric nephrology unit with vascular access-related obstacles in children undergoing hemodialysis for ESKD.
- To analyze the types of vascular access used and their associated complications in a pediatric hemodialysis population.
Main Methods:
- Retrospective analysis of vascular access data for 187 children with ESKD undergoing regular hemodialysis from 2019 to 2021.
- Kaplan-Meier survival analysis was employed for arteriovenous fistula (AVF) and cuffed catheter outcomes.
Main Results:
- Uncuffed central venous catheters (CVCs) were the predominant VA (97.3%), with arteriovenous fistulas (AVFs) created in only 2.7% before HD initiation.
- Tunneled CVCs were inserted in 56 patients (29.9%), and AVFs were created in 79 patients (42.2%).
- Catheter-related bacteremia was the most frequent complication for both uncuffed and cuffed CVCs, although rates differed significantly. AVFs demonstrated an 83% success rate with a mean functioning duration of over 750 days.
Conclusions:
- Native AVF is the ideal vascular access for pediatric hemodialysis, but its creation is often limited by small vessel size in children.
- Non-cuffed CVCs can serve as a viable, relatively long-term alternative when AVF creation is not feasible.
- The transhepatic (TH) technique for CVC insertion into the inferior vena cava (IVC) offers a solution for challenging cases with occluded central veins.
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