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Kidney Week

Abstract: FR-PO428

Characteristics and Outcomes of Arteriovenous Fistula in Hemodialysis Pediatric Patients: Impact of the Monocyte-to-Lymphocyte Ratio in Access Dysfunction

Session Information

  • Pediatric Nephrology - I
    November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Brás, Ana Catarina, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Lisboa, Portugal
  • Faria, Maria, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
  • Sousa, Patrícia, Hospital Senhora da Oliveira, Guimarães, Portugal
  • Teixeira, Ana, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
  • Costa, Teresa Vieira, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
  • Teixeira, Gabriela, Centro Hospitalar Tamega e Sousa EPE, Penafiel, Portugal
  • Almeida, Paulo Jc, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
  • Mota, Conceição, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
Background

Arteriovenous fistula (AVF) is considered the gold-standard access in adult and pediatric patients on hemodialysis (HD). Age and size combined with vessel immaturity can pose a challenge in creating AVF in children. We aimed to compare distal (dAVF) and proximal AVF (pAVF) regarding patency rates, complications and outcomes in a population of pediatric HD patients and evaluate the impact of monocyte-to-lymphocyte ratio (MLR) in access dysfunction.

Methods

All patients aged 0 to 18 years who underwent AVF creation for HD between January 2004 and May 2022 were included.

Results

We evaluated 33 patients with a median age of 13 years (IQR 5); 58% male. Median weight at time of AVF construction was 41kg (IQR 21.5); 30% weighted less than 30kg. The most frequent etiology of kidney disease was congenital anomalies of kidney and urinary tract (64%). Most patients (75%) underwent kidney replacement therapy previous to AVF construction. Of the AVF constructed, 46% were dAVF (radiocephalic) and 54% pAVF (brachiocephalic and brachiobasilic). Primary failure rate was 27%. Primary and secondary patency rate at one year were 62.5% and 93.8% respectively. AVF related complications were stenosis/thrombosis (54%), ischemic steal syndrome (6%) and high flow/aneurismatic AVF (6%). Regarding outcomes, 64% received a kidney transplant (KT) (median time of 11 months (mo) (IQR 21)); 6% died. Patients with pAVF were younger (p=0.03) and smaller (p=0.001). Median secondary patency was 29 mo (IQR 36.5) and 6.5 mo (IQR 10.8) in pAVF and dAVF respectively (p=0.01). There was no statistical significance regarding primary patency, AVF related complications or outcomes between the two groups. There was no association between MLR and access dysfunction.

Conclusion

Achieving a functional vascular access while sparing vascular territory for the future is of most importance in pediatrics. We showed that pediatric patients with pAVF as first access, although younger and smaller, had longer acccess patency and no more complications than those with dAVF. Although larger studies are needed, these results demonstrate the safety and efficacy of building such accesses in these patients. We found no association between MLR and access dysfunction.