title: Vascular access for chronic hemodialysis in children: arteriovenous fistula or central venous catheter?
abstract: BACKGROUND
  The choice of vascular access (VA) for hemodialysis (HD) in end-stage renal disease (ESRD) is arteriovenous fistula (AVF) or central venous catheter (CVC). Whereas clinical practice guidelines suggest AVF to preserve the vascular bed, pediatric nephrologists tend to favor CVC for shorter-term dialysis. Our objective was to determine whether pediatric priority allocation policies for deceased-donor kidneys affect VA planning.
  
  
  METHODS
  Pediatric priority for deceased-donor kidneys was instituted in Quebec in 2004. We retrospectively compared clinical practice on AVF, CVC, wait time on transplant list, HD duration in pre-policy (group A) and post-policy (group B) from 1997-2011.
  
  
  RESULTS
  We identified 78 patients with a median age of 14.7 years (range, 0.7-20.5 years) and weight of 46 kg (12.5-95 kg); AVF decreased from 76 % in group A to 41 % in group B (p = 0.002). Wait times on transplant list were significantly reduced: median 413.5 days (range, 2-1,910 days) in group A vs. 89 days (range, 18-692 days) in group B (p = 0.003). Time on HD for deceased-donor recipients was shorter: 705 (range, 51-1,965 days) group A vs. 349.5 days (range, 158-1,060 days) group B (p = 0.01).
  
  
  CONCLUSIONS
  This is the first study to document VA changes related to pediatric priority allocation policy. Our fistula-first center saw a shift toward CVC-first.
authors.affiliation: Pediatric Nephrology, Dialysis Unit, Department of Pediatrics, Sainte Justine Hospital (CHU Sainte-Justine), University of Montreal, 3175 Côte Sainte Catherine, Montreal, QC, H3T 1C5, Canada, aicha.merouani.hsj@ssss.gouv.qc.ca.
authors.forename: Aicha
authors.initials: A
authors.lastname: Merouani
authors.forename: Michel
authors.initials: M
authors.lastname: Lallier
authors.forename: Julie
authors.initials: J
authors.lastname: Paquet
authors.forename: Johanne
authors.initials: J
authors.lastname: Gagnon
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Lapeyraque
mesh_terms: D000293:Adolescent; D001166:Arteriovenous Shunt, Surgical; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D061665:Time-to-Treatment; D014850:Waiting Lists; D055815:Young Adult
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