1. Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients.
- Author
-
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, and Couloures, Olivera Marsenic
- 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 - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF