Pediatric vascular access for hemodialysis: Feasibility and outcome

Abstract

Objective: This study was conducted to evaluate different vascular accesses for hemodialysis in the pediatric age groupin our locality as regards feasibility, complications, and outcomes.Patients and Methods: This was a prospective, descriptive, longitudinal nonrandomized study with an analyticalcomponent that was conducted on pediatric patients suffering from chronic renal failure. Patients were divided into twogroups according to the clinical evaluation and duplex assessment. Group 1 was submitted to arteriovenous fistula (AVF).This group included 79 cases, while group 2 was submitted to a permanent central venous catheter (CVC). This groupincluded 41 cases.Results: Primary patency among the studied groups was 88.6% for AVFs and 92.7% for permanent catheters at 3 months(P=0.4). At 6 months, 82.3% of AVFs remained patent compared to 85.4% for permanent catheters (P=0.6). At 9 months,AVFs had a patency of 79.7%atent versus 70.7% for permanent catheters (P=0.2). At 12 months, AVFs had a patencyof 78.5% compared to 51.2% for permanent catheters (P=0.002). At 18 months, AVFs had a patency of 62% comparedwith 24.4% for permanent catheters (P≤0.001). At 24 months, AVFs had a patency of 54.4%whereas permanent cathetershad a patency of 4.9% (P≤0.001). There were 22.8% with thrombosis and 0% with infection in AVFs and 34.15% withthrombosis and 26.83% with infection in permanent catheters.Conclusion: CVCs permit less effective hemodialysis and are accompanied by much higher complications and accessfailure rates in comparison to AVFs, resulting in earlier consumption of the vascular access reserve in patients facing yearsof renal replacement therapy. The detected high rate of transient uncuffed CVCs used temporarily in patients with AVFproposes frequent suboptimal vascular access planning in these patients.