Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients.
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.
Pediatric nephrology (Berlin, Germany)
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
Arteriovenous fistula; Arteriovenous graft; Pediatric hemodialysis; Primary patency; Secondary patency
Onder AM, Flynn JT, Billings AA, et al. Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients [published correction appears in Pediatr Nephrol. 2019 Jan 25;:]. Pediatr Nephrol. 2019;34(2):329-339. doi:10.1007/s00467-018-4082-4