Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry
Language English Country United States Media print-electronic
Document type Journal Article, Observational Study, Research Support, Non-U.S. Gov't
PubMed
31010601
DOI
10.1053/j.ajkd.2019.02.014
PII: S0272-6386(19)30616-X
Knihovny.cz E-resources
- Keywords
- Pediatric dialysis, access dysfunction, access infection, access revision, adolescents, arteriovenous fistula (AVF), arteriovenous graft (AVG), central venous catheter (CVC), children, end-stage renal disease (ESRD), long-term hemodialysis, registry data, vascular access,
- MeSH
- Arteriovenous Shunt, Surgical * adverse effects MeSH
- Blood Vessel Prosthesis * adverse effects MeSH
- Renal Dialysis adverse effects methods MeSH
- Child MeSH
- Internationality MeSH
- Catheterization, Central Venous * adverse effects MeSH
- Clinical Decision-Making MeSH
- Humans MeSH
- Adolescent MeSH
- Prospective Studies MeSH
- Registries MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
RATIONALE & OBJECTIVE: Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS: Clinical rather than population-based data. CONCLUSIONS: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.
Center for Pediatrics and Adolescent Medicine Heidelberg Germany
Cerrahpasa School of Medicine Istanbul University Istanbul Turkey
Charité Virchow Klinikum Berlin Germany
Children's Dialysis Center Strasbourg France
Children's Hospital University of Helsinki and Helsinki University Central Hospital Helsinki Finland
Children's Mercy Hospital Kansas City KS
Department of Pediatric Nephrology Cukurova University Faculty of Medicine Adana Turkey
Department of Pediatrics Nephrology and Hypertension Medical University of Gdansk Gdansk Poland
Department of Pediatrics SMDZ in Zabrze SUM in Katowice Poland
Fundan University Shanghai China
Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom
Hôpital Femme Mere Enfant Hospices Civils de Lyon Lyon France
Istanbul University Medical Faculty; Koc University School of Medicine Istanbul Turkey
Kidney Center for Children and Adolescents Seoul Korea
Kuala Lumpur Hospital Kuala Lumpur Malaysia
Mitera Children's Hospital Athens Greece
MTA SE Pediatric and Nephrology Research Group Budapest Hungary
Pediatric Nephrology Unit CHU Arnaud de Villeneuve Université de Montpellier Montpellier France
References provided by Crossref.org
