TY - JOUR
T1 - Predictors of time to first cannulation for arteriovenous fistula in pediatric hemodialysis patients
T2 - Midwest Pediatric Nephrology Consortium study
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
AU - Jetton, Jennifer
AU - Fathallah-Shaykh, Sahar
AU - Ranch, Daniel
AU - Aviles, Diego
AU - Copelovitch, Lawrence
AU - Ellis, Eileen
AU - Chadha, Vimal
AU - Elmaghrabi, Ayah
AU - Lin, Jen Jar
AU - Butani, Lavjay
AU - Haddad, Maha
AU - Marsenic, Olivera
AU - Brakeman, Paul
AU - Quigley, Raymond
AU - Shin, H. Stella
AU - Garro, Rouba
AU - Liu, Hui
AU - Rahimikollu, Javad
AU - Raina, Rupesh
AU - Langman, Craig B.
AU - Wood, Ellen
N1 - Publisher Copyright:
© 2019, IPNA.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Permanent vascular access (PVA) is preferred for long-term hemodialysis. Arteriovenous fistulae (AVF) have the best patency and the lowest complication rates compared to arteriovenous grafts (AVG) and tunneled cuffed catheters (TCC). However, AVF need time to mature. This study aimed to investigate predictors of time to first cannulation for AVF in pediatric hemodialysis patients. Methods: Data on first AVF and AVG of patients at 20 pediatric dialysis centers were collected retrospectively, including demographics, clinical information, dialysis markers, and surgical data. Statistical modeling was used to investigate predictors of outcome. Results: First PVA was created in 117 children: 103 (88%) AVF and 14 (12%) AVG. Mean age at AVF creation was 15.0 ± 3.3 years. AVF successfully matured in 89 children (86.4%), and mean time to first cannulation was 3.6 ± 2.5 months. In a multivariable regression model, study center, age, duration of non-permanent vascular access (NPVA), and Kt/V at AVF creation predicted time to first cannulation, with study center as the strongest predictor (p < 0.01). Time to first cannulation decreased with increasing age (p = 0.03) and with increasing Kt/V (p = 0.01), and increased with duration of NPVA (p = 0.03). Secondary failure occurred in 10 AVF (11.8%). Time to first cannulation did not predict secondary failure (p = 0.29), but longer time to first cannulation tended towards longer secondary patency (p = 0.06). Conclusions: Study center is the strongest predictor of time to first cannulation for AVF and deserves further investigation. Time to first cannulation is significantly shorter in older children, with more efficient dialysis treatments, and increases with longer NPVA duration.
AB - Background: Permanent vascular access (PVA) is preferred for long-term hemodialysis. Arteriovenous fistulae (AVF) have the best patency and the lowest complication rates compared to arteriovenous grafts (AVG) and tunneled cuffed catheters (TCC). However, AVF need time to mature. This study aimed to investigate predictors of time to first cannulation for AVF in pediatric hemodialysis patients. Methods: Data on first AVF and AVG of patients at 20 pediatric dialysis centers were collected retrospectively, including demographics, clinical information, dialysis markers, and surgical data. Statistical modeling was used to investigate predictors of outcome. Results: First PVA was created in 117 children: 103 (88%) AVF and 14 (12%) AVG. Mean age at AVF creation was 15.0 ± 3.3 years. AVF successfully matured in 89 children (86.4%), and mean time to first cannulation was 3.6 ± 2.5 months. In a multivariable regression model, study center, age, duration of non-permanent vascular access (NPVA), and Kt/V at AVF creation predicted time to first cannulation, with study center as the strongest predictor (p < 0.01). Time to first cannulation decreased with increasing age (p = 0.03) and with increasing Kt/V (p = 0.01), and increased with duration of NPVA (p = 0.03). Secondary failure occurred in 10 AVF (11.8%). Time to first cannulation did not predict secondary failure (p = 0.29), but longer time to first cannulation tended towards longer secondary patency (p = 0.06). Conclusions: Study center is the strongest predictor of time to first cannulation for AVF and deserves further investigation. Time to first cannulation is significantly shorter in older children, with more efficient dialysis treatments, and increases with longer NPVA duration.
KW - Arteriovenous fistula
KW - Arteriovenous graft
KW - Hemodialysis
KW - Maturation time
KW - Pediatric
KW - Time to first cannulation
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U2 - 10.1007/s00467-019-04396-3
DO - 10.1007/s00467-019-04396-3
M3 - Article
C2 - 31696356
AN - SCOPUS:85074812620
SN - 0931-041X
VL - 35
SP - 287
EP - 295
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 2
ER -