POS-580 CLINICAL PROFILE AND OUTCOME OF ARTERIO-VENOUS FISTULAE IN CHILDREN ON MAINTENANCE HEMODIALYSIS - A SINGLE CENTRE STUDY FROM A LOW RESOURCE COUNTRY

Abstract

Arteriovenous fistula (AVF)is the recommended vascular access for children and adolescents needing maintenance hemodialysis(MH). The International Pediatric Hemodialysis Network, found that only a quarter of children undergo MH through an AVF with wide variability across countries. In low resource countries, the need to maintain a functional vascular access becomes critical given the long waiting time to transplantation. We studied the clinical profile and outcomes of arteriovenous fistulae in children on MH. A retrospective analysis was undertaken of children who had an AVF created for MH between 2005 and 2020 at a tertiary care hospital. All children had mapping of the artery and vein of the non-dominant hand prior to creation of the AVF. Complication occurring in the first 6 weeks of fistula creation were considered “early complications”. Primary patency was defined as the duration from the time of maturation to the first complication requiring intervention. The time to loss of primary patency and the risk factors for the same were analysed. The outcome of the fistula was classified as primary fistula failure (failure of fistula to mature) and secondary fistula failure (failure of fistula after maturation). Ethical approval from the Institutional Ethics Committee was obtained. Thirty-six children with 38 AVFs (28 boys [77%]) with median age of 11(8,13) years and median body weight 26 (24, 31.2) kgs were included. Thirteen (36%) had glomerular disease; 29 (80%) children were on maintenance hemodialysis for a median duration of 4(2, 6) months via a central venous catheter prior to AVF creation. Majority of children had a brachiocephalic fistula (27 (75%), the remaining had radiocephalic (7(19.4%) and brachio-basilic fistula (2(5.5%). The median follow-up time was 20.8 (7.3, 46.8) months. Median dimension of artery and vein were 2.1(1.9, 2.4) mm and 2.6(2.4, 2.8) mm respectively. Four children (11%) had early complications within a median duration of 2 (1,3) days. Of these, two had thrombosis and two had poor flow and absent thrill. The two AVFs with thrombosis could be salvaged with thrombectomy resulting in a primary failure rate of 2/36 (5.5%). Among the rest (n=34), the median time to maturation of the fistula was 7 (6.5, 9) weeks. Of these, 3 lost their fistula after a median duration 85 (79, 120) months with a secondary failure rate of 8.8%. Ten patients (27.7%) had thrombosis requiring intervention with median time to loss of primary patency of 72 (27, 134) months (Figure 1). The loss of primary patency was not associated with age, type of kidney disease, site of fistula or hemodialysis vintage. At last follow up, 16 (47%) patients continued hemodialysis with the same AVF, 2 required a new AVF (from radiocephalic to brachiocephalic fistula), 9 underwent transplantation within a median duration of 29 (12, 35) months, 1 switched to peritoneal dialysis and six were lost to follow up with a functioning AVF. For children on MH from low resource settings, where early transplantation remains a challenge, early AVF creation is a feasible option for vascular access. AVF is associated with few early complications, appreciable primary patency and low failure rates.