MO1028: Vascular Access Type in Haemodialysis Paediatrics Patients—From Central Venous Catheter to Arteriovenous Fistula

Abstract

Abstract BACKGROUND AND AIMS Haemodialysis (HD) in children has become progressively more used, the efficiency of the treatment, as well as the technical improvements, are evident. Permanent access in the form of a fistula is the preferred type of vascular access (VA) for most paediatric patients on maintenance HD. However, age-related anatomical limitations, shorter waiting times for transplantation, or lack of paediatric/surgical expertise limit its use. Central venous catheter (CVC) remains the most used access in children. Here we present the results of the last 14 years of experience in paediatric HD vascular access from a reference centre in northern Portugal. METHOD A retrospective descriptive study of patients admitted to our paediatric HD Unit between January 2007 and December 2021. Clinical data were collected from medical records. RESULTS In total 46 patients were enrolled, mainly boys (n = 26, 56.5%), mean age at admission 10.8 + 5.3 years (1–17), 39.1% weighing ˂ 30 kg (n = 18) and 17.4% ˂15 kg (n = 8). More than half were incident patients starting on HD (n = 25, 54.3%), 45.7% (n = 21) were transferred from peritoneal dialysis (PD) and one patient had a previous kidney transplant (KT). Regarding CKD etiology, 52.2% (n = 24) were mainly due to congenital anomalies of the kidney and urinary tract; chronic glomerulonephritis was responsible for 19.6% of cases (n = 9). Most patients started HD with a CVC (n = 38, 82.6%), including two patients with an arteriovenous fistula (AVF) who required a temporary CVC until fistula maturation. At the end of follow-up, about 43.5% (n = 20) of the patients ended up with an AVF (compared with 17.4% at the beginning) and, not surprisingly, 90% (n = 18) of them weighed ˃ 30 kg and only one child ˂ 15 kg. The mean duration of dialysis was 1.1 + 0.5 years (1 month–8 years); 28 patients were submitted to KT (60.9%), 7 transferred to PD (15.2%) and 4 (8.7%) remain on HD. Average waiting times for KT are quite longer in patients with AVF (1.56 years), in comparison to CVC (0.584 years). CONCLUSION In children, choosing the best vascular access remains a challenge. CVCs continue to be the most used type of vascular access. This option can be justified by the limitations of smaller patients, the expectation of a short waiting time for KT and the need to cannulate every other day (with the pain and fear associated with it). CVCs were associated with less effective dialysis and higher complication rates. On the other hand, AVFs have shown excellent long-term patency in paediatric HD patients. In our group, no significant complications were reported and no thrombosis occurred.