ESPN 51th Annual Meeting

ESPN 2018


 
Arteriovenous fistulae are associated with fewer complications and improved dialysis efficacy compared to central venous catheters: Findings from the International Pediatric Hemodialysis Network
Dagmara Borzych-Duzalka 1 Rukshana Shroff 2 Gema Ariceta 3 Yok-Chin Yap 4 Fabio Paglialonga 5 Hong Xu 6 Hee Gyung Kang 7 Dominik Muller 8 Aysun Karabay Bayazit 9 Constantinos John Stefanidis 10 Marc Fila 11 Lale Sever 12 Karel Vondrak 13 Attila Szabo 14 Maria Szczepanska 15 Bruno Ranchin 16 Tuula Holtta 17 Ariane Zaloszyc 18 Ilmay Bilge 19 Bradley A Warady 20 Franz Schaefer 21 Claus Peter Schmitt 21

1- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
2- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
3- Hospital Universitario Materno-Infantil Vall D Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
4- Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
5- Fondazione IRCCS Ca Granda, Osp. Maggiore Policlinico, Milano, Italy
6- Fundan University, Shanghai, China
7- Kidney Center for Children and Adolescents, Seoul, Korea
8- Charite, Virchow Klinikum, Berlin, Germany
9- Cukurova University, Faculty of Medicine, Department of Pediatric Nephrology, Adana, Turkey
10- Mitera Children’s Hospital, Athens, Greece
11- Arnaud de Villeneuve - Universite de Montpellier, Montpellier, France
12- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
13- University Hospital Motol, Prague, Czech Republic
14- MTA-SE Pediatric and Nephrology Research Group, Budapest, Hungary
15- Department of Pediatrics, SMDZ in Zabrze, SUM in Katowice, Poland
16- HĂ´pital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
17- University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
18- Childrens Dialysis Center, Strassbourg, France
19- Koc University, School of Medicine, Istambul, Turkey
20- Childrens Mercy Hospital, Kansas City, USA
21- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
 
Introduction:

While arteriovenous fistulae (AVF) have been recommended as the preferred vascular access for pediatric patients on chronic hemodialysis (HD), comparative performance and outcome information is scant.

Material and methods:

We analyzed vascular access choice, placement, performance and outcome in 552 children prospectively monitored in the International Pediatric Hemodialysis Network.

 

 

Results:

During 314 cumulative patient years, 628 central venous catheters (CVC), 225 AVF and 17 arteriovenous grafts (AVG) were placed. 9 AVG were placed following AVF, 3 following CVC failure. A transient, uncuffed CVC was first placed in 32% of AVF and 3% of CVC patients (p<0.001) and used for 51 (51; 113) and 83 (36;286) days, respectively (p=0.01). Access choice was driven by age and independent of country specific waiting time until transplantation. Average blood flow and Kt/V were higher with AVF than with CVC. AVF use independently predicted higher hemoglobin level. Infectious complications were reported with CVC only (1/26 months), were independent of disinfectant type and frequency of access care, and required access replacement in 45%. CVC dysfunction rate was 1/13 months, was more frequent with subclavian and femoral compared to internal jugular sites (p=0.002), and was manifested by poor flow rate in 66% of cases, with thrombolytic treatment being successful in only 19% of the cases. AVF dysfunction rate was 1/28 months, in 58% due to thrombosis, and required a new access in 44% of all cases. Primary and secondary AVF patency rates were higher after one, two, three and four years (p<0.0001 versus CVC). CVC use increased the need for a new access at a different site by twofold (p<0.01).

 

Conclusions:

CVC remains the predominant vascular access in children on HD, despite being associated with poorer dialysis efficacy and higher infectious and non-infectious complication rates compared to AVF. This results in higher access replacement rates, consuming the long-term vascular access reserve.