title: Vascular access survival in children and young adults receiving long-term hemodialysis.
abstract: BACKGROUND
  The delivery of long-term hemodialysis therapy in children is complicated by smaller vascular caliber and the potential lifelong requirement for hemodialysis access. Various factors have resulted in the increased use of cuffed central venous catheters (CVLs) in preference to autologous arteriovenous fistulae (AVFs) and arteriovenous synthetic grafts (AVGs). The aim of this study is to compare CVL, AVF, and AVG survival and determine factors affecting their survival.
  
  
  METHODS
  A 20-year retrospective study was undertaken of pediatric patients receiving long-term hemodialysis therapy. Age, height, weight, body mass index, and sex were noted at each procedure, in addition to the presence of hypoalbuminemia, underlying diagnosis, type and site of vascular access, and effect of previous access surgery. The grade of operator also was noted.
  
  
  RESULTS
  Three hundred four vascular access procedures were performed on 114 patients, with a median age at initial access formation of 12.0 years (range, 4 weeks to 21.9 years). The most common procedure was CVL insertion (182 procedures) and then AVF formation (107 procedures), with only 15 AVGs created. Median censored survival was 3.14 years (95% confidence interval, 1.22 to 5.06) for AVFs and 0.6 years (95% confidence interval, 0.20 to 1.00) for CVLs. Factors adversely affecting vascular access survival were younger age, trainee operator, presence of hypoalbuminemia, and type of access undertaken, with AVF better than CVL.
  
  
  CONCLUSIONS
  This study shows increased survival of AVFs over CVLs and AVGs. Vascular access in children and adolescents may impact on future dialysis accessibility and should be undertaken by those most experienced in each technique.
authors.affiliation: Renal Unit, Royal Hospital for Sick Children, Glasgow, Scotland. ian.ramage@yorkhill.scot.nhs.uk
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Ramage
authors.forename: Alan
authors.initials: A
authors.lastname: Bailie
authors.forename: Kay S
authors.initials: KS
authors.lastname: Tyerman
authors.forename: John H
authors.initials: JH
authors.lastname: McColl
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Pollard
authors.forename: Maggie M
authors.initials: MM
authors.lastname: Fitzpatrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D007223:Infant; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D015993:Life Tables; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000925:Anticoagulants