Abstract
Complications of vascular access in children with chronic end-stage renal disease
Highlights
Obtaining vascular access that allows long-term hemodialysis of children with stage 5D chronic kidney disease is a priority in the management of these patients
Proper vascular access is a key factor in the treatment of children on hemodialysis (HD) and is represented by three variants: tunneled central venous catheters (CVLs), arteriovenous fistulas (AVFs), and arteriovenous grafts (AVG) that use biological or prosthetic material [1]
CVLs allow for relatively easy mounting, immediate use, and needle-free dialysis, but have multiple disadvantages, including infections, thrombosis, and stenosis, that can lead to central vein obstruction and reduced chances of developing AVF in the future [3,4]
Summary
Obtaining vascular access that allows long-term hemodialysis of children with stage 5D chronic kidney disease is a priority in the management of these patients. The objective of the study was to assess complications of vascular access in children on long-term hemodialysis by arteriovenous fistula or central venous line. We followed 40 patients in the hemodialysis program for a period of 18 months; in 22, vascular access was by arteriovenous fistula, and 18 were dialyzed on a central venous line. Complications of venous access in children with hemodialysis are very common and have a major impact on the morbidity and quality of life of these patients In this context, a multidisciplinary team (pediatric nephrologist, specialist in vascular imaging, and vascular surgeon) is needed to follow these patients in order to prevent and treat these complications. AVFs have a significant primary failure rate (25% in children [4] and up to 40% reported in adult patients [5]) and long maturation times, and require highly experienced vascular surgeons, they have the advantages of a lower rate of infections, fewer hospitalizations, and greater longevity than CVLs
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