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 group in our locality as regards feasibility, complications, and outcomes. Patients and Methods: This was a prospective, descriptive, longitudinal nonrandomized study with an analytical component that was conducted on pediatric patients suffering from chronic renal failure. Patients were divided into two groups 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 group included 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 patency of 78.5% compared to 51.2% for permanent catheters ( P=0.002 ). At 18 months, AVFs had a patency of 62% compared with 24.4% for permanent catheters ( P≤0.001 ). At 24 months, AVFs had a patency of 54.4%whereas permanent catheters had a patency of 4.9% ( P≤0.001 ). There were 22.8% with thrombosis and 0% with infection in AVFs and 34.15% with thrombosis and 26.83% with infection in permanent catheters. Conclusion: CVCs permit less effective hemodialysis and are accompanied by much higher complications and access failure rates in comparison to AVFs, resulting in earlier consumption of the vascular access reserve in patients facing years of renal replacement therapy. The detected high rate of transient uncuffed CVCs used temporarily in patients with AVF proposes frequent suboptimal vascular access planning in these patients