Vascular access complications in long-term pediatric hemodialysis patients.
Current data demonstrate pediatric patients who remain on hemodialysis (HD) therapy are more likely to be dialyzed via central venous catheters (CVCs) than arteriovenous grafts (AVGs) and fistulae (AVFs). We retrospectively compared complications and health-related quality of life (HRQOL) associated with different vascular access types at two large centers over a 1-year period. Patients included in the study were younger than 25 years of age, weighed >20 kg, and had received HD for at least 3 months. Thirty CVC patients and 21 AVG/AVF patients received a total of 2,393 and 3,506 HD treatments, respectively. The infectious complication rate was higher for CVC patients, who were hospitalized 3.7 days for each 100 HD treatments versus 0.2 days for AVG/AVF patients (p < 0.01). CVC patients also had a much higher rate of access revision, needing 2.7 hospital days every 100 HD treatments compared with 0.2 days for AVG/AVF patients (p < 0.01). HRQOL scores did not differ between groups. Thus, despite similar HRQOL, CVCs were associated with more complications and greater morbidity when compared with AVG/AVFs. These findings further emphasize the need to use AVG/AVFs as primary HD access for pediatric patients expected to receive a long course of maintenance HD.
Zaritsky
Joshua J
JJ
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. jzaritsky@mednet.ucla.edu
Salusky
Isidro B
IB
Gales
Barbara
B
Ramos
Georgina
G
Atkinson
James
J
Allsteadt
Amelia
A
Brandt
Mary L
ML
Goldstein
Stuart L
SL
D000293:Adolescent; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction; D011788:Quality of Life; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult