Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients

on behalf of the Midwest Pediatric Nephrology Consortium

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
JournalPediatric Nephrology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Arteriovenous Fistula
Fistula
Blood Vessels
Renal Dialysis
Pediatrics
Transplants
Survival
Odds Ratio
Vascular Patency
Demography
Thigh
Arm
Guidelines
Kidney

Keywords

  • Arteriovenous fistula
  • Arteriovenous graft
  • Pediatric hemodialysis
  • Primary patency
  • Secondary patency

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Cite this

Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients. / on behalf of the Midwest Pediatric Nephrology Consortium.

In: Pediatric Nephrology, 01.01.2018.

Research output: Contribution to journalArticle

@article{06976d02244647ff878d4e0f465ea140,
title = "Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients",
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.",
keywords = "Arteriovenous fistula, Arteriovenous graft, Pediatric hemodialysis, Primary patency, Secondary patency",
author = "{on behalf of the Midwest Pediatric Nephrology Consortium} and Onder, {Ali Mirza} and Flynn, {Joseph T.} and Billings, {Anthony A.} and Fang Deng and Marissa DeFreitas and Chryso Katsoufis and Grinsell, {Matthew M.} and Patterson, {Larry T.} and Jennifer Jetton and Sahar Fathallah-Shaykh and Daniel Ranch and Diego Aviles and Lawrence Copelovitch and Eileen Ellis and Vimal Chanda and Ayah Elmaghrabi and Lin, {Jen Jar} and Lavjay Butani and Maha Haddad and Couloures, {Olivera Marsenic} and Paul Brakeman and Raymond Quigley and {Stella Shin}, H. and Rouba Garro and Hui Liu and Javad Rahimikollu and Rupesh Raina and Langman, {Craig B.} and Wood, {Ellen G.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00467-018-4082-4",
language = "English (US)",
journal = "Pediatric Nephrology",
issn = "0931-041X",
publisher = "Springer Verlag",

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TY - JOUR

T1 - Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients

AU - on behalf of the Midwest Pediatric Nephrology Consortium

AU - Onder, Ali Mirza

AU - Flynn, Joseph T.

AU - Billings, Anthony A.

AU - Deng, Fang

AU - DeFreitas, Marissa

AU - Katsoufis, Chryso

AU - Grinsell, Matthew M.

AU - Patterson, Larry T.

AU - Jetton, Jennifer

AU - Fathallah-Shaykh, Sahar

AU - Ranch, Daniel

AU - Aviles, Diego

AU - Copelovitch, Lawrence

AU - Ellis, Eileen

AU - Chanda, Vimal

AU - Elmaghrabi, Ayah

AU - Lin, Jen Jar

AU - Butani, Lavjay

AU - Haddad, Maha

AU - Couloures, Olivera Marsenic

AU - Brakeman, Paul

AU - Quigley, Raymond

AU - Stella Shin, H.

AU - Garro, Rouba

AU - Liu, Hui

AU - Rahimikollu, Javad

AU - Raina, Rupesh

AU - Langman, Craig B.

AU - Wood, Ellen G.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Arteriovenous fistula

KW - Arteriovenous graft

KW - Pediatric hemodialysis

KW - Primary patency

KW - Secondary patency

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UR - http://www.scopus.com/inward/citedby.url?scp=85053918126&partnerID=8YFLogxK

U2 - 10.1007/s00467-018-4082-4

DO - 10.1007/s00467-018-4082-4

M3 - Article

C2 - 30264215

AN - SCOPUS:85053918126

JO - Pediatric Nephrology

JF - Pediatric Nephrology

SN - 0931-041X

ER -