Outcomes of Arteriovenous Fistula for Hemodialysis in Pediatric and Adolescent Patients

Abstract

Purpose: This retrospective review aimed to report the outcomes of arteriovenousfistula (AVF) and to evaluate the suitability of AVF as a permanent vascular accessin pediatric populations. Materials and Methods: Data were collected for all patients aged 0 to 19 yearswho underwent AVF creation for hemodialysis between January 2000 and June 2014. Results: Fifty-two AVFs were created in 47 patients. Mean age was 15.7±3.2 yearsand mean body weight was 46.7±15.4 kg. Of the 52 AVFs, 43 were radiocephalicAVFs, 7 were brachiocephalic AVFs and 2 were basilic vein transpositions. Witha mean follow-up of 49.7±39.2 months, primary patency was 60.5%, 51.4%,and 47.7% at 1, 3, and 5 years, respectively and secondary patency was 82.7%,79.2% and 79.2% at 1, 3, and 5 years, respectively. Age, body weight, AVF type,the presence of a central venous catheter, use of anticoagulation therapy, andhistory of vascular access failure were not significantly associated with patencyrates. There were 9 cases (17.3%) of primary failure; low body weight was anindependent predictor. Excluding cases of primary failure, the mean duration ofmaturation was 10.0±3.7 weeks. During follow-up, 20 patients (42.6%) underwentkidney transplantation, with a median interval to transplantation of 36 months. Conclusion: AVF creation in children and adolescents is associated with acceptablelong-term durability, primary failure rate and maturation time. Considering thewaiting time and limited kidney graft survival, placement of AVFs should beconsidered primarily even in patients expected to receive transplantation.