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- Title
Hemodialysis vascular access and subsequent transplantation: a report from the ESPN/ERA-EDTA Registry.
- Authors
Boehm, Michael; Bonthuis, Marjolein; Noordzij, Marlies; Harambat, Jérôme; Groothoff, Jaap W.; Melgar, Ángel Alonso; Buturovic, Jadranka; Dusunsel, Ruhan; Fila, Marc; Jander, Anna; Koster-Kamphuis, Linda; Novljan, Gregor; Ortega, Pedro J.; Paglialonga, Fabio; Saravo, Maria T.; Stefanidis, Constantinos J.; Aufricht, Christoph; Jager, Kitty J.; Schaefer, Franz
- Abstract
Background: Current guidelines advocate use of arteriovenous fistula (AVF) over central venous catheter (CVC) for children starting hemodialysis (HD). European data on current practice, determinants of access choice and switches, patient survival, and access to transplantation are limited.Methods: We included incident patients from 18 European countries who started HD from 2000 to 2013 for whom vascular access type was reported to the ESPN/ERA-EDTA Registry. Data were evaluated using descriptive statistics, logistic and Cox regression models, and cumulative incidence competing risk analysis.Results: Three hundred ninety-three (55.1%) of 713 children started HD with a CVC and were more often females, younger, had more often an unknown diagnosis, glomerulonephritis, or vasculitis, and lower hemoglobin and height-SDS at HD initiation. AVF patients were 91% less likely to switch to a second access, and two-year patient survival was 99.6% (CVC, 97.2%). Children who started with an AVF were less likely to receive a living donor transplant (adjusted HR, 0.30; 95% CI, 0.16-0.54) and more likely to receive a deceased donor transplant (adjusted HR, 1.50; 95% CI, 1.17-1.93), even after excluding patients who died or were transplanted in the first 6 months.Conclusions: CVC remains the most frequent type of vascular access in European children commencing HD. Our results suggest that the choice for CVC is influenced by the time of referral, rapid onset of end-stage renal disease, young age, and an expected short time to transplantation. The role of vascular access type on the pattern between living and deceased donation in subsequent transplantation requires further study.
- Subjects
EUROPE; AGE factors in disease; CHRONIC kidney failure; CONFIDENCE intervals; REPORTING of diseases; ARTERIOVENOUS fistula; GLOMERULONEPHRITIS; HEALTH services accessibility; HEMODIALYSIS; HEMOGLOBINS; KIDNEY transplantation; MEDICAL referrals; MEDICAL practice; ORGAN donors; PEDIATRICS; REGRESSION analysis; RISK assessment; VASCULITIS; LOGISTIC regression analysis; PROPORTIONAL hazards models; CENTRAL venous catheters; PATIENTS' attitudes; DESCRIPTIVE statistics; ODDS ratio
- Publication
Pediatric Nephrology, 2019, Vol 34, Issue 4, p713
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-018-4129-6