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Abstract: PO1327

Conversion to Arteriovenous Fistula but Not Arteriovenous Graft Is Associated with Improved Hemodialysis Efficacy Markers in Children: Pediatric Nephrology Research Consortium Study

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Onder, Ali Mirza, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
  • Anasri, Md Abu Yusuf, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Langman, Craig B., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Katsoufis, Chryso P., University of Miami School of Medicine, Miami, Florida, United States
  • Defreitas, Marissa J., University of Miami School of Medicine, Miami, Florida, United States
  • Wood, Ellen G., SSM Health Cardinal Glennon Children's Hospital, Saint Louis, Missouri, United States
Background

Arteriovenous fistulae (AVF) and arteriovenous grafts (AVG) are preferred vascular access for chronic hemodialysis (HD) patients. Our objective was to investigate the impact of switching from tunneled cuffed catheters (TCC) to AVF or AVG on HD efficacy markers in pediatric HD patients.

Methods

Retrospective chart reviews were completed on individual patients from 20 pediatric HD centers. All the patients used TCC prior to AVF/ AVG and each patient acted as his/her own control. Data on dialysis efficacy markers were collected at creation of AVF/AVG and for two years follow-up, along with patient demographics and clinical information. Statistical methods used included hypothesis testing and statistical modeling after adjusting for relevant demographic variables.

Results

First PVA was created in 98 individual children: 87 (89%) were AVF and 11 (11%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4± 17.3 months. At one-year follow-up, AVF patients improved the Kt/V by 0.23 (p=0.008) and URR by 5.4% (P<0.001). At second year follow-up, both Kt/V and URR remained higher than values at creation (p=0.02, p<0.0001, respectively), being similar to first year’s values (p=0.57, p=0.36, respectively). Furthermore, AVF patients improved serum albumin by 0.33 gram/dl (p<0.0001) and serum hematocrit by 2.94% (p<0.0001) at one-year and maintained similar improved values at second year follow-up (p=0.001, p=0.003, respectively). These observations were further supported by the adjusted models. Children with AVG did not demonstrate any statistically significant change in Kt/V, URR, serum albumin or hematocrit at either one-year or second year follow-ups.

Conclusion

Switching to AVF was associated with improved HD efficacy markers (Kt/V, URR, serum albumin and hematocrit). Surprisingly, conversion to AVG was not associated with a similar positive impact for the above markers.