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

BackgroundHemodialysis (HD) guidelines recommend permanent vascular access (PVA) in children unlikely to receive kidney transplant within 1year of starting HD. We aimed to determine predictors of primary and secondary patency of PVA in pediatric HD patients.MethodsRetrospective chart reviews were performed for first PVAs in 20 participating centers. Variables collected included patient demographics, complications, interventions, and final outcome.ResultsThere 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.ConclusionsIn 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.