Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry

Borzych-Dużałka, Dagmara; Shroff, Rukshana; Ariceta, Gema; Yap, Yok Chin; Paglialonga, Fabio; Xu, Hong; Kang, Hee Gyung; Thumfart, Julia; Aysun, Karabay Bayazit; Stefanidis, Constantinos J.; Fila, Marc; Sever, Lale; Vondrák, Karel; Szabó, Attila; Szczepańska, Maria; Ranchin, Bruno; Hölttä, Tuula; Zaloszyc, Ariane; Bilge, İlmay; Warady, Bradley A.; Schaefer, Franz; Schmitt, Claus Peter

doi:10.1053/j.ajkd.2019.02.014

Cited by 52 publications

(50 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Not unexpectedly, Borzych-Duzalka et al report complication rates that are much higher for CVCs when compared with AVFs, including infectious complications (absent in children dialyzed with an AVF), reduced measures of dialysis adequacy (Kt/V urea ), need for greater access maintenance and replacement procedures to restore blood flow necessary for HD, and higher erythropoietin resistance. 8 While this aligns with data reported from smaller scale studies, the authors validate a universal theme: CVC use is associated with increased morbidity.…”

supporting

confidence: 77%

“…The reliance on timely transplantation to justify the high rate of CVC use was also challenged by the authors of the IPHN Registry study, who found that those receiving HD with a CVC awaiting transplantation waited a median of 14 months, with one-quarter of patients remaining on dialysis therapy for more than 3 years. 8 This speaks to the relative unpredictability of transplantation and the need to focus on expeditious catheter removal if one wants to minimize long-term risks of these devices and optimize dialysis treatment.…”

mentioning

confidence: 99%

“…No patients were dialyzed with an AVF/ AVG at 6 months, and only 3%, within 18 months, with this value eventually reaching 27% within 36 months of starting HD. 8 These low conversion rates highlight an apparent lack of urgency or effectiveness in disassociating the pediatric HD patient from the CVC for HD vascular access. Perhaps when a CVC is placed, its removal may be deemed unnecessary or inconvenient.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Catheter Craze Continues for Pediatric Hemodialysis Vascular Access: The Need to Move From Catheter First to Catheter Last

Valentini

Chand

2019

American Journal of Kidney Diseases

View full text Add to dashboard Cite

supporting

confidence: 77%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Catheter Craze Continues for Pediatric Hemodialysis Vascular Access: The Need to Move From Catheter First to Catheter Last

Valentini

Chand

2019

American Journal of Kidney Diseases

View full text Add to dashboard Cite

“…After CVC insertion, the risks of infection, catheter malfunction due to thrombus or fibrin sheath formation, and venous stenosis persist. Infection is the most common cause of CVC removal and replacement, and its incidence is highest in CVC compared to AVF or AVG 6,17 . A 2013 retrospective study of 25 children, 5 with CVC and 20 with AVF, found that the infection rate in children with CVC was 3.2/100 patient‐months, while it was 0.25/100 patient‐months in children with AVF ( p = 0.002) 18 .…”

Section: Modalities Of Long‐term Vascular Accessmentioning

confidence: 99%

Challenges of long‐term vascular access in pediatric hemodialysis: Recommendations for practitioners

Raina

Joshi

Chakraborty

et al. 2020

Hemodialysis International

View full text Add to dashboard Cite

Kidney transplantation is the preferred treatment of end‐stage renal disease in children. However, time to transplant varies, making a well‐functioning long‐term vascular access essential for performing hemodialysis efficiently and without disruption until a kidney becomes available. However, establishing long‐term vascular access in pediatric patients can present distinct challenges due to this population's unique characteristics, such as smaller body size and lower‐diameter blood vessels. There are three main pediatric long‐term vascular access options, which include central venous catheters (CVC), arteriovenous fistula (AVF), and arteriovenous graft (AVG). CVC are currently the most widely used modality, although various studies and guidelines recommend AVF or AVG as the preferred option. Although AVF should be used whenever possible, it is crucial that clinicians consider factors such as patient size, physical exam findings, comorbidities, predicted duration of treatment to decide on the most optimal long‐term vascular access modality. This article reviews the three long‐term vascular access methods in children and the benefits and complications of each.

show abstract

“…Despite the expected 'short-term' period, children often remain on HD for extended periods of time. The International Pediatric Hemodialysis Network Registry recently reported that those receiving HD via a CVC and awaiting transplantation waited a median of 14 months, with one-quarter of patients remaining on dialysis therapy for more than 3 years [3]. However, for longer term HD, consideration should be given to form an arteriovenous fistula (AVF), as long-term HD via a CVC carries significant risks including infection, malfunction, inadequate dialysis, hospitalisation, and central venous stenosis [4].…”

Section: Introductionmentioning

confidence: 99%

Silent and dangerous: catheter-associated right atrial thrombus (CRAT) in children on chronic haemodialysis

et al. 2020

View full text Add to dashboard Cite

Background Catheter-associated right atrial thrombus (CRAT) is a recognised complication of central venous catheter (CVC) use for haemodialysis (HD) patients. Methods This was a single-centre retrospective longitudinal observational study of consecutive children aged 6 months–18 years over a 7-year period receiving in-centre chronic HD. Echocardiograms as per routine cardiac surveillance were performed 6 months or earlier given clinical concerns. Results Sixty-five children, 36 boys (55.4%), median (IQR) age 11.8 (5.3, 14.7) years, received HD for kidney failure with replacement therapy (KFRT). Initial modality was HD in 45 (69.2%), with CVC as initial access in 42 (93.3%) and AVF in 3 (6.7%); in the remaining 20 (30.8%) patients PD was the initial modality before switching to HD. Seven of 65 (10.8%) developed CRAT at median 2 (0.8, 8.4) months from CVC insertion, with one CRAT detected 3 days following insertion. One child had 2 episodes of CRAT and one additionally thrombosed their AVF. No patient had an underlying primary kidney disease associated with a pro-thrombotic state. Those with CRAT were younger, had more frequent CVC change and received dialysis for longer duration compared to those with no CRAT. Six episodes of CRAT (75%) received anticoagulation therapy. Infective complications were observed in 25% and catheter malfunction in 50%. Five CRAT episodes (62.5%) resulted in CVC loss. One patient died after a haemorrhagic complication of anticoagulation and sepsis, and another developed life-threatening superior vena cava obstruction syndrome. Overall mortality 14% (1/7). Conclusions This is the first report of CRAT in a paediatric HD population. There was ~ 11% incidence of CRAT in patients receiving chronic HD detected by surveillance echocardiography. Although frequently asymptomatic, CRAT is associated with serious sequelae. Anticoagulation and surveillance with expert echocardiography remain mainstays of management. Graphical abstract

show abstract

Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry

Cited by 52 publications

References 30 publications

Catheter Craze Continues for Pediatric Hemodialysis Vascular Access: The Need to Move From Catheter First to Catheter Last

Catheter Craze Continues for Pediatric Hemodialysis Vascular Access: The Need to Move From Catheter First to Catheter Last

Challenges of long‐term vascular access in pediatric hemodialysis: Recommendations for practitioners

Silent and dangerous: catheter-associated right atrial thrombus (CRAT) in children on chronic haemodialysis

Contact Info

Product

Resources

About