Vascular access for chronic hemodialysis in children: arteriovenous fistula or central venous catheter?

Background The choice of vascular access (VA) for hemodialysis (HD) in end-stage renal disease (ESRD) is arteriovenous fistula (AVF) or central venous catheter (CVC). Whereas clinical practice guidelines suggest AVF to preserve the vascular bed, pediatric nephrologists tend to favor CVC for shorter-term dialysis. Our objective was to determine whether pediatric priority allocation policies for deceased-donor kidneys affect VA planning. Methods Pediatric priority for deceased-donor kidneys was instituted in Quebec in 2004. We retrospectively compared clinical practice on AVF, CVC, wait time on transplant list, HD duration in pre-policy (group A) and post-policy (group B) from 1997-2011. Results We identified 78 patients with a median age of 14.7 years (range, 0.7-20.5 years) and weight of 46 kg (12.5-95 kg); AVF decreased from 76% in group A to 41%ingroupB (p = 0.002). Waittimes on transplant list were significantly reduced: median 413.5 days (range, 21,910 days) in group A vs. 89 days (range, 18-692 days) in group B (p = 0.003). Time on HD for deceased-donor recipients was shorter: 705 (range, 51-1,965 days) group A vs. 349.5 days (range, 158-1,060 days) group B (p = 0.01). Conclusions This is the first study to document VA changes related to pediatric priority allocation policy. Our fistula-first center saw a shift toward CVC-first. Keywords Arteriovenous fistula * End-stage renal disease * Kidney transplantation * Pediatric chronic hemodialysis * Pediatric priority for deceased-donor kidneys * Vascular access
Introduction Transplantation is the renal replacement therapy of choice for children with end-stage renal disease (ESRD) [1]. The most commonly used modality while awaiting a kidney transplant is hemodialysis, rather [...]