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

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A Correction to this article was published on 25 January 2019

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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.

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Change history

  • 25 January 2019

    The original version of this article unfortunately contained a mistake. The name of Vimal Chadha was presented incorrectly. The corrected author list is given above.

  • 25 January 2019

    The original version of this article unfortunately contained a mistake. The name of Vimal Chadha was presented incorrectly. The corrected author list is given above.

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Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Le Bonheur Children’s Hospital, University of Tennessee, School of Medicine, 49 N Dunlop Street, Faculty Office Building, Room 322, Memphis, TN, 38105, USA

    Ali Mirza Onder

  2. Division of Nephrology, Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Joseph T. Flynn

  3. Department of Statistics, West Virginia University, Morgantown, WV, USA

    Anthony A. Billings & Javad Rahimikollu

  4. Kidney Diseases Division, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Fang Deng & Craig B. Langman

  5. Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children’s Hospital, University of Miami Leonard M Miller School of Medicine, Miami, FL, USA

    Marissa DeFreitas & Chryso Katsoufis

  6. Division of Pediatric Nephrology, Primary Children’s Hospital, University of Utah, Salt Lake City, UT, USA

    Matthew M. Grinsell

  7. Division of Pediatric Nephrology, Children’s National Health System, Washington, DC, USA

    Larry T. Patterson

  8. Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA

    Jennifer Jetton

  9. Division of Pediatric Nephrology, Children’s of Alabama, University of Alabama, Birmingham, AL, USA

    Sahar Fathallah-Shaykh

  10. Division of Pediatric Nephrology, University of Texas Health Science Center, San Antonio, TX, USA

    Daniel Ranch

  11. Division of Pediatric Nephrology, Children’s Hospital New Orleans, LSU Heath School of Medicine, New Orleans, LA, USA

    Diego Aviles

  12. Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Lawrence Copelovitch

  13. Division of Pediatric Nephrology, Arkansas Children’s Hospital, Little Rock, AR, 72202, USA

    Eileen Ellis

  14. Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, MO, USA

    Vimal Chanda

  15. Division of Pediatric Nephrology, Children’s Medical Center Dallas, UT Southwestern, Dallas, TX, USA

    Ayah Elmaghrabi & Raymond Quigley

  16. Division of Pediatric Nephrology, Brenner Children’s Hospital, Wake Forest University, Winston Salem, NC, USA

    Jen-Jar Lin

  17. Division of Pediatric Nephrology, UC Davis Children’s Hospital, Sacramento, CA, USA

    Lavjay Butani & Maha Haddad

  18. Division of Pediatric Nephrology, Yale New Haven Children’s Hospital, Yale University School of Medicine, New Haven, CT, 06504, USA

    Olivera Marsenic Couloures

  19. Division of Pediatric Nephrology, UCSF Benioff Children’s Hospital, San Francisco, CA, USA

    Paul Brakeman

  20. Division of Pediatric Nephrology, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    H. Stella Shin & Rouba Garro

  21. Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA

    Hui Liu

  22. Division of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, USA

    Rupesh Raina

  23. Department of Pediatrics, Division of Pediatric Nephrology, SSM Cardinal Glennon Children’s Hospital, Saint Louis University, St. Louis, MO, USA

    Ellen G. Wood

Authors
  1. Ali Mirza Onder
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  2. Joseph T. Flynn
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  3. Anthony A. Billings
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  4. Fang Deng
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  6. Chryso Katsoufis
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  7. Matthew M. Grinsell
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  8. Larry T. Patterson
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  9. Jennifer Jetton
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  10. Sahar Fathallah-Shaykh
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  11. Daniel Ranch
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  12. Diego Aviles
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  13. Lawrence Copelovitch
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  14. Eileen Ellis
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  15. Vimal Chanda
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  16. Ayah Elmaghrabi
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  17. Jen-Jar Lin
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  18. Lavjay Butani
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  19. Maha Haddad
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  20. Olivera Marsenic Couloures
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  21. Paul Brakeman
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  22. Raymond Quigley
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  23. H. Stella Shin
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  24. Rouba Garro
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  25. Hui Liu
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  26. Javad Rahimikollu
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  27. Rupesh Raina
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  28. Craig B. Langman
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  29. Ellen G. Wood
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on behalf of the Midwest Pediatric Nephrology Consortium

Corresponding author

Correspondence to Ali Mirza Onder.

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Each participating center obtained approval for retrospective data collection from their local institutional review boards (IRB). None of the contributors from the respective dialysis centers had reported any conflict of interests.

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Onder, A.M., Flynn, J.T., Billings, A.A. et al. Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients. Pediatr Nephrol 34, 329–339 (2019). https://doi.org/10.1007/s00467-018-4082-4

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  • DOI: https://doi.org/10.1007/s00467-018-4082-4

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