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- Title
Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients.
- Authors
Onder, Ali Mirza; Flynn, Joseph T.; Billings, Anthony A.; Deng, Fang; DeFreitas, Marissa; Katsoufis, Chryso; Grinsell, Matthew M.; Patterson, Larry T.; Jetton, Jennifer; Fathallah-Shaykh, Sahar; Ranch, Daniel; Aviles, Diego; Copelovitch, Lawrence; Ellis, Eileen; Chanda, Vimal; Elmaghrabi, Ayah; Lin, Jen-Jar; Butani, Lavjay; Haddad, Maha; Couloures, Olivera Marsenic
- Abstract
Background: Hemodialysis (HD) guidelines recommend permanent vascular access (PVA) in children unlikely to receive kidney transplant within 1 year of starting HD. We aimed to determine predictors of primary and secondary patency of PVA in pediatric HD patients.Methods: Retrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome.Results: There were 103 arterio-venous fistulae (AVF) and 14 AV grafts (AVG). AVF demonstrated superior primary (p = 0.0391) and secondary patency (p = 0.0227) compared to AVG. Primary failure occurred in 16 PVA (13.6%) and secondary failure in 14 PVA (12.2%). AVF were more likely to have primary failure (odds ratio (OR) = 2.10) and AVG had more secondary failure (OR = 3.33). No demographic, clinical, or laboratory variable predicted primary failure of PVA. Anatomical location of PVA was predictive of secondary failure, with radial having the lowest risk compared to brachial (OR = 12.425) or femoral PVA (OR = 118.618). Intervention-free survival was predictive of secondary patency for all PVA (p = 0.0252) and directly correlated with overall survival of AVF (p = 0.0197) but not AVG. Study center demonstrated statistically significant effect only on intervention-free AVF survival (p = 0.0082), but not number of complications or interventions, or outcomes.Conclusions: In this multi-center pediatric HD cohort, AVF demonstrated primary and secondary patency advantages over AVG. Radial PVA was least likely to develop secondary failure. Intervention-free survival was the only predictor of secondary patency for AVF and directly correlated with overall access survival. The study center effect on intervention-free survival of AVF deserves further investigation.
- Subjects
FEMORAL artery; ARTERIOVENOUS fistula; HEMODIALYSIS patients; LONGITUDINAL method; VASCULAR resistance; MEDICAL cooperation; PEDIATRICS; RESEARCH; SURVIVAL; TRANSPLANTATION of organs, tissues, etc.; BRACHIAL artery; TREATMENT effectiveness; MEDICAL records; RETROSPECTIVE studies; ODDS ratio
- Publication
Pediatric Nephrology, 2019, Vol 34, Issue 2, p329
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-018-4082-4