Chand Deepa H, Bednarz Dale, Eagleton Matthew, Krajewski Leonard
Pediatric Nephrology and Hypertension, Akron Children's Hospital, Akron, Ohio 44308, USA.
Semin Dial. 2009 Nov-Dec;22(6):679-83. doi: 10.1111/j.1525-139X.2009.00638.x. Epub 2009 Oct 2.
The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends the use of a permanent vascular access for pediatric hemodialysis (HD) patients; however, central venous catheters are the most common vascular access used among children. In children receiving HD, central venous catheters, while suboptimal, are the most common vascular access used. As such, it is imperative that pediatric HD providers optimize vascular access techniques. We report outcomes of arteriovenous fistula (AVF) creation by a single surgeon in pediatric HD patients dialyzed at a single center. We further describe our experience and outcomes with the use of the operating microscope in the United States in children receiving HD under 15 kg in weight and as young as 4 years of age. AVF usage rates as well as short- and long-term patency rates can be quite high with proper management. We further illustrate that the Fistula First principles can be applied to the pediatric population in the setting of a single surgeon with single center experience. As such, we have surpassed the current NKF-DOQI recommendation of 50% fistula use in prevalent HD patients.
美国国家肾脏基金会透析预后质量倡议（NKF-DOQI）建议为小儿血液透析（HD）患者使用永久性血管通路；然而，中心静脉导管是儿童中最常用的血管通路。在接受HD的儿童中，中心静脉导管虽然并非最佳选择，但却是最常用的血管通路。因此，小儿HD医疗服务提供者必须优化血管通路技术。我们报告了在单一中心接受透析的小儿HD患者中，由一位外科医生创建动静脉内瘘（AVF）的结果。我们还进一步描述了在美国，体重不足15kg、年仅4岁的接受HD的儿童中使用手术显微镜的经验和结果。通过适当管理，AVF的使用率以及短期和长期通畅率可能会相当高。我们进一步说明，在有单一中心经验的单一外科医生的情况下，“内瘘优先”原则可应用于儿科患者群体。因此，我们已经超过了NKF-DOQI目前关于在HD患者中内瘘使用率达50%的建议。
