Permanent vascular access survival in children on long-term chronic hemodialysis.
The aim of this study is to report a single-center experience regarding the management and outcome of permanent vascular accesses (VA) in children on chronic hemodialysis (HD). We analyzed the survival of permanent VA in 79 pediatric patients with end-stage renal disease patients on chronic HD between January 2000 and December 2008. One hundred and thirty-seven VA [89 native fistulas (AVFs) and 48 grafts (AVGs)] were created in 79 children. The creation of AVFs was significantly more frequent in children weighing >25 kg and AVGs in children weighing <25 kg (p = 0.003). The 1-year primary patency rate was 50% for AVF and 30% for AVG. The secondary patency rates at 1, 2, and 3 years for AVFs were 73, 50, and 20% and for AVGs were 64, 36, and 20%, respectively. The total number of surgical and endovascular interventions was significantly higher in AVGs (p <or=0.05). Access stenosis, thrombosis and infection episodes occurred more frequently in AVG (p = 0.02). VAs had a high rate of interventions. Our study demonstrated better results of AVFs formation over AVGs, for long-term HD access in pediatrics. Surveillance and radiologic procedures are necessary for early detection and treatment of access complications in order to extend access survival.
Department of Nephrology, Hemodialysis Unit, Hospital de Pediatría Prof JP Garrahan, Buenos Aires, Argentina. lmbriones@gmail.com
Liliana
L
Briones
Alexia
A
Diaz Moreno
Sergio
S
Sierre
Laura
L
Lopez
José
J
Lipsich
Marta
M
Adragna
D000293:Adolescent; D017541:Aneurysm, False / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001118:Argentina; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013530:Surgical Wound Infection / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D014654:Vascular Patency