title: Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease.
abstract: BACKGROUND
  Transplantation is the optimal therapy for pediatric end-stage renal disease (ESRD) patients, but in a subset of patients with peritoneal membrane failure, failed transplants or poor social situations, chronic hemodialysis (HD) remains the only option. Long-term survival of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in pediatric patients has not been well described.
  
  
  METHODS
  We studied the survival of permanent vascular access in 34 pediatric ESRD patients treated with chronic HD at our institution between 1/1/89 and 12/1/95 and followed to 12/31/2000.
  
  
  RESULTS
  Twenty-four AVFs and 28 AVGs were created in 19 and 23 patients, respectively. Mean age and weight at insertion were 15.1 years (range 7.1 to 20.9) and 46 kg (18 to 81) for AVFs and 13.3 years (3.8 to 21.1) and 41.5 kg (10.5 to 145) for AVGs. Fifteen patients weighed <35 kg at the time of access creation (7 AVFs in 5 patients, 14 AVGs in 13 patients). Excluding primary failures, one-year, three-year and five-year patency rates for AVFs (74%, 59%, 59%) and AVGs (96%, 69%, 40%) were not significantly different. Patency did not correlate with patient weight or age at access creation. Primary access failure occurred more often (P < 0.01) in AVFs (8/24) compared to AVGs (1/28). Access thrombosis, stenosis and infection occurred more frequently in AVG (P = 0.02).
  
  
  CONCLUSIONS
  Both AVF and AVG function well even in small pediatric patients and have survival rates equivalent to adult series and longer than cuffed venous catheters in pediatric patients. Both AVFs and AVGs are preferable for long-term HD access in pediatrics.
authors.affiliation: Department of Pediatrics, and Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA. rsheth@bcm.tmc.edu
authors.forename: Rita D
authors.initials: RD
authors.lastname: Sheth
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.forename: Eileen D
authors.initials: ED
authors.lastname: Brewer
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.forename: Arundhati S
authors.initials: AS
authors.lastname: Kale
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006083:Graft Occlusion, Vascular / Q000401:mortality; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000401:mortality*; D016019:Survival Analysis; D013927:Thrombosis / Q000401:mortality; D017211:Treatment Failure