Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry.
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
Journal
American journal of kidney diseases : the official journal of the National Kidney Foundation
ISSN: 1523-6838
Titre abrégé: Am J Kidney Dis
Pays: United States
ID NLM: 8110075
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
29
04
2018
accepted:
12
02
2019
pubmed:
24
4
2019
medline:
19
3
2020
entrez:
24
4
2019
Statut:
ppublish
Résumé
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. Prospective observational cohort study. 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. Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. 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/V Clinical rather than population-based data. 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.
Identifiants
pubmed: 31010601
pii: S0272-6386(19)30616-X
doi: 10.1053/j.ajkd.2019.02.014
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
193-202Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.