Abstract: FR-PO782
Characteristics of Permanent Vascular Access of Young Children (≤12 Years Old) on Chronic Hemodialysis
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Pagi, Reut Ron, Children's Hospital of Michigan, Detroit, Michigan, United States
- Kapur, Gaurav, Children's Hospital of Michigan, Detroit, Michigan, United States
- Valentini, Rudolph P., Children's Hospital of Michigan, Detroit, Michigan, United States
- Jain, Amrish, Children's Hospital of Michigan, Detroit, Michigan, United States
- Mattoo, Tej K., Children's Hospital of Michigan, Detroit, Michigan, United States
- Baracco, Rossana, Children's Hospital of Michigan, Detroit, Michigan, United States
Background
Hemodialysis (HD) is the most commonly used dialysis modality in children with end stage renal disease. Because of perceived proximity to transplantation and smaller blood vessels in children, central venous catheters (CVC) remain the most commonly used access for children in the United States and are more frequently used over a permanent access: either an arteriovenous fistula (AVF) or arteriovenous graft (AVG). The aim of this study was to compare efficacy and complications of these HD accesses in young children.
Methods
This was a retrospective chart review of patients who started chronic HD at age ≤12yo from 2008 to 2016. Data collected and compared included age and weight of the patient, infectious and non-infectious complications and hospital admissions related to the access; as well as treatment characteristics at 6 months including adequacy of dialysis (Kt/V), hematocrit, albumin, erythropoietin dose and calcitriol dose.
Results
There were 39 accesses used by 19 patients (16 CVC’s, 16 AVF’s and 7 AVG’s). Medians were 8 years (1 – 12) for age and 23.4kg (6.6 – 110.7) for weight. Median days on HD per patient was 696 (317 – 1826). Treatment characteristics at 6 months showed that Kt/V was 2 for permanent access and 1.42 for CVC (p=0.03). Albumin and hematocrit were not significantly different between the 2 groups. Patients with CVC required 33% more erythropoietin and 100% more calcitriol than the patients with permanent access, however, this difference was not statistically significant. Patients using permanent access had lower rates of infectious complications, total complications, hospital admissions and shorter hospital stays (p<0.01 for all categories).
Conclusion
Commitment to using permanent access (AVG or AVF) in young children on chronic HD led to more cost-effective care in view of decreased complications, hospitalizations and better adequacy of dialysis.
Access Related Complications per 100 Days of HD (mean)
| CVC | Permanent access | P value | |
| Bloodstream infections (BSI) | 0.61 | 0.03 | <0.001 |
| Hospital days secondary to BSI | 2.32 | 0.13 | <0.001 |
| Antibiotic treatment days secondary to BSI | 9.32 | 0.50 | <0.001 |
| Admissions related to access complications | 0.95 | 0.40 | <0.001 |
| Total complications | 0.93 | 0.52 | <0.001 |
| Hospital days related to access | 3.05 | 1.21 | <0.001 |