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Pediatr Nephrol. 2018 Dec 26. doi: 10.1007/s00467-018-4129-6. [Epub ahead of print]

Hemodialysis vascular access and subsequent transplantation: a report from the ESPN/ERA-EDTA Registry.

Author information

1
Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria.
2
Department of Medical Informatics, Amsterdam Public Health research institute, ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. m.bonthuis@amc.uva.nl.
3
Department of Medical Informatics, Amsterdam Public Health research institute, ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
4
Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France.
5
Department of Paediatric Nephrology, Emma Children's Academic Medical Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
6
Pediatric Nephrology Unit, Hospital 'La Paz', Madrid, Spain.
7
Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.
8
Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
9
Department of Pediatric Nephrology, Montpellier University Hospital, Montpellier, France.
10
Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, Łódź, Poland.
11
Department of Pediatric Nephrology, Amalia Children's Hospital Radboud University Medical Center, Nijmegen, The Netherlands.
12
Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.
13
Department of Pediatric Nephrology, Hospital Universitari La Fe, Valencia, Spain.
14
Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca'Granda Ospedal Maggiore Policlinico, Milan, Italy.
15
Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy.
16
Department of Nephrology, P&A Kyriakou Children's Hospital, Athens, Greece.
17
Department of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany.

Abstract

BACKGROUND:

Current guidelines advocate use of arteriovenous fistula (AVF) over central venous catheter (CVC) for children starting hemodialysis (HD). European data on current practice, determinants of access choice and switches, patient survival, and access to transplantation are limited.

METHODS:

We included incident patients from 18 European countries who started HD from 2000 to 2013 for whom vascular access type was reported to the ESPN/ERA-EDTA Registry. Data were evaluated using descriptive statistics, logistic and Cox regression models, and cumulative incidence competing risk analysis.

RESULTS:

Three hundred ninety-three (55.1%) of 713 children started HD with a CVC and were more often females, younger, had more often an unknown diagnosis, glomerulonephritis, or vasculitis, and lower hemoglobin and height-SDS at HD initiation. AVF patients were 91% less likely to switch to a second access, and two-year patient survival was 99.6% (CVC, 97.2%). Children who started with an AVF were less likely to receive a living donor transplant (adjusted HR, 0.30; 95% CI, 0.16-0.54) and more likely to receive a deceased donor transplant (adjusted HR, 1.50; 95% CI, 1.17-1.93), even after excluding patients who died or were transplanted in the first 6 months.

CONCLUSIONS:

CVC remains the most frequent type of vascular access in European children commencing HD. Our results suggest that the choice for CVC is influenced by the time of referral, rapid onset of end-stage renal disease, young age, and an expected short time to transplantation. The role of vascular access type on the pattern between living and deceased donation in subsequent transplantation requires further study.

KEYWORDS:

Access to transplantation; Arteriovenous fistula; Central venous catheter; End-stage renal disease in children; Renal replacement therapy

PMID:
30588548
DOI:
10.1007/s00467-018-4129-6

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