Vascular access complications in long-term pediatric hemodialysis patients
- PDF / 99,366 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 95 Downloads / 183 Views
ORIGINAL ARTICLE
Vascular access complications in long-term pediatric hemodialysis patients Joshua J. Zaritsky & Isidro B. Salusky & Barbara Gales & Georgina Ramos & James Atkinson & Amelia Allsteadt & Mary L. Brandt & Stuart L. Goldstein
Received: 13 February 2008 / Revised: 9 June 2008 / Accepted: 1 July 2008 / Published online: 19 August 2008 # IPNA 2008
Abstract Current data demonstrate pediatric patients who remain on hemodialysis (HD) therapy are more likely to be dialyzed via central venous catheters (CVCs) than arteriovenous grafts (AVGs) and fistulae (AVFs). We retrospectively compared complications and health-related quality of life (HRQOL) associated with different vascular access types at two large centers over a 1-year period. Patients included in the study were younger than 25 years of age, weighed >20 kg, and had received HD for at least 3 months. Thirty CVC patients and 21 AVG/AVF patients received a J. J. Zaritsky : I. B. Salusky : B. Gales : G. Ramos Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA J. Atkinson Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA A. Allsteadt Renal Dialysis Unit, Texas Children’s Hospital, Houston, TX, USA M. L. Brandt Micheal E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, CA, USA S. L. Goldstein Department of Pediatrics-Renal Section, Baylor College of Medicine, Houston, CA, USA J. J. Zaritsky (*) A2-383 MDCC, 650 Charles Young Dr, Los Angeles, CA 90095-1752, USA e-mail: [email protected]
total of 2,393 and 3,506 HD treatments, respectively. The infectious complication rate was higher for CVC patients, who were hospitalized 3.7 days for each 100 HD treatments versus 0.2 days for AVG/AVF patients (p1 year [2]. Despite this recommendation, CVCs continue to serve as the most prevalent vascular access in the pediatric population, with close to 80% of pediatric maintenance hemodialysis patients using CVCs as vascular access [3]. Permanent access prevalence rates in the form of an AVF or AVG are only 5%, 13.5%, and 21.5% at 1, 2,
2062
and 3 years, respectively [3]. Prevalence rates are somewhat better in adolescent patients, although data from the Center for Medicare & Medicaid Clinical Performance Measures Project demonstrate 56% of adolescents receive hemodialysis via CVCs for at least 2 consecutive years [4]. The potential rationale for increased relative CVC prevalence includes perceived difficulties in creating and using permanent access in children and shortened time spent on dialysis therapy as a bridge to transplantation [5]. An additional factor that may influence selection of CVCs over permanent access is the reluctance of children to endure the pain associated with access cannulation, which in turn may negatively influence the patients overall health related quality of life (HRQOL). A recent study in adult patients, however, revealed patients dialyzed persistently via an AVF actually reported better HRQOL [6]. Although there is consistent evidence showi
Data Loading...
