Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients
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.
| Errataetall: | |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:34 |
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| Enthalten in: |
Pediatric nephrology (Berlin, Germany) - 34(2019), 2 vom: 27. Feb., Seite 329-339 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Onder, Ali Mirza [VerfasserIn] |
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| Links: |
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| Themen: |
Arteriovenous fistula |
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| Anmerkungen: |
Date Completed 02.04.2020 Date Revised 02.04.2020 published: Print-Electronic ErratumIn: Pediatr Nephrol. 2019 Jan 25;:. - PMID 30684015 Citation Status MEDLINE |
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| doi: |
10.1007/s00467-018-4082-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM289000661 |
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| 100 | 1 | |a Onder, Ali Mirza |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 02.04.2020 | ||
| 500 | |a Date Revised 02.04.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Pediatr Nephrol. 2019 Jan 25;:. - PMID 30684015 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a METHODS: Retrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Arteriovenous fistula | |
| 650 | 4 | |a Arteriovenous graft | |
| 650 | 4 | |a Pediatric hemodialysis | |
| 650 | 4 | |a Primary patency | |
| 650 | 4 | |a Secondary patency | |
| 700 | 1 | |a Flynn, Joseph T |e verfasserin |4 aut | |
| 700 | 1 | |a Billings, Anthony A |e verfasserin |4 aut | |
| 700 | 1 | |a Deng, Fang |e verfasserin |4 aut | |
| 700 | 1 | |a DeFreitas, Marissa |e verfasserin |4 aut | |
| 700 | 1 | |a Katsoufis, Chryso |e verfasserin |4 aut | |
| 700 | 1 | |a Grinsell, Matthew M |e verfasserin |4 aut | |
| 700 | 1 | |a Patterson, Larry T |e verfasserin |4 aut | |
| 700 | 1 | |a Jetton, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Fathallah-Shaykh, Sahar |e verfasserin |4 aut | |
| 700 | 1 | |a Ranch, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Aviles, Diego |e verfasserin |4 aut | |
| 700 | 1 | |a Copelovitch, Lawrence |e verfasserin |4 aut | |
| 700 | 1 | |a Ellis, Eileen |e verfasserin |4 aut | |
| 700 | 1 | |a Chanda, Vimal |e verfasserin |4 aut | |
| 700 | 1 | |a Elmaghrabi, Ayah |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Jen-Jar |e verfasserin |4 aut | |
| 700 | 1 | |a Butani, Lavjay |e verfasserin |4 aut | |
| 700 | 1 | |a Haddad, Maha |e verfasserin |4 aut | |
| 700 | 1 | |a Couloures, Olivera Marsenic |e verfasserin |4 aut | |
| 700 | 1 | |a Brakeman, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Quigley, Raymond |e verfasserin |4 aut | |
| 700 | 1 | |a Stella Shin, H |e verfasserin |4 aut | |
| 700 | 1 | |a Garro, Rouba |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Hui |e verfasserin |4 aut | |
| 700 | 1 | |a Rahimikollu, Javad |e verfasserin |4 aut | |
| 700 | 1 | |a Raina, Rupesh |e verfasserin |4 aut | |
| 700 | 1 | |a Langman, Craig B |e verfasserin |4 aut | |
| 700 | 1 | |a Wood, Ellen G |e verfasserin |4 aut | |
| 700 | 0 | |a Midwest Pediatric Nephrology Consortium |e verfasserin |4 aut | |
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