Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients.

Document Type

Article

Publication Date

2-2019

Identifier

DOI: 10.1007/s00467-018-4082-4

Abstract

BACKGROUND: Hemodialysis (HD) guidelines recommend permanent vascular access (PVA) in children unlikely to receive kidney transplant within 1 year of starting HD. We aimed to determine predictors of primary and secondary patency of PVA in pediatric HD patients.

METHODS: Retrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome.

RESULTS: There were 103 arterio-venous fistulae (AVF) and 14 AV grafts (AVG). AVF demonstrated superior primary (p = 0.0391) and secondary patency (p = 0.0227) compared to AVG. Primary failure occurred in 16 PVA (13.6%) and secondary failure in 14 PVA (12.2%). AVF were more likely to have primary failure (odds ratio (OR) = 2.10) and AVG had more secondary failure (OR = 3.33). No demographic, clinical, or laboratory variable predicted primary failure of PVA. Anatomical location of PVA was predictive of secondary failure, with radial having the lowest risk compared to brachial (OR = 12.425) or femoral PVA (OR = 118.618). Intervention-free survival was predictive of secondary patency for all PVA (p = 0.0252) and directly correlated with overall survival of AVF (p = 0.0197) but not AVG. Study center demonstrated statistically significant effect only on intervention-free AVF survival (p = 0.0082), but not number of complications or interventions, or outcomes.

CONCLUSIONS: In this multi-center pediatric HD cohort, AVF demonstrated primary and secondary patency advantages over AVG. Radial PVA was least likely to develop secondary failure. Intervention-free survival was the only predictor of secondary patency for AVF and directly correlated with overall access survival. The study center effect on intervention-free survival of AVF deserves further investigation.

Journal Title

Pediatric nephrology (Berlin, Germany)

Volume

34

Issue

2

First Page

329

Last Page

339

MeSH Keywords

Adolescent; Arteriovenous Shunt, Surgical; Canada; Child; Female; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Retrospective Studies; Risk Factors; Time Factors; Treatment Failure; United States; Vascular Grafting; Vascular Patency

Keywords

Arteriovenous fistula; Arteriovenous graft; Pediatric hemodialysis; Primary patency; Secondary patency

Comments

Erratum in

  • Correction to: Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients. Onder AM, Flynn JT, Billings AA, Deng F, DeFreitas M, Katsoufis C, Grinsell MM, Patterson LT, Jetton J, Fathallah-Shaykh S, Ranch D, Aviles D, Copelovitch L, Ellis E, Chadha V, Elmaghrabi A, Lin JJ, Butani L, Haddad M, Couloures OM, Brakeman P, Quigley R, Shin HS, Garro R, Liu H, Rahimikollu J, Raina R, Langman CB, Wood EG; Midwest Pediatric Nephrology Consortium.Pediatr Nephrol. 2019 Aug;34(8):1483-1484. doi: 10.1007/s00467-019-4199-0.PMID: 30684015

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