Department of Nephrology, Hemodialysis Unit, Hospital de Pediatría Prof JP Garrahan, Buenos Aires, Argentina.
Pediatr Nephrol. 2010 Sep;25(9):1731-8. doi: 10.1007/s00467-010-1553-7. Epub 2010 Jun 2.
The aim of this study is to report a single-center experience regarding the management and outcome of permanent vascular accesses (VA) in children on chronic hemodialysis (HD). We analyzed the survival of permanent VA in 79 pediatric patients with end-stage renal disease patients on chronic HD between January 2000 and December 2008. One hundred and thirty-seven VA [89 native fistulas (AVFs) and 48 grafts (AVGs)] were created in 79 children. The creation of AVFs was significantly more frequent in children weighing >25 kg and AVGs in children weighing <25 kg (p = 0.003). The 1-year primary patency rate was 50% for AVF and 30% for AVG. The secondary patency rates at 1, 2, and 3 years for AVFs were 73, 50, and 20% and for AVGs were 64, 36, and 20%, respectively. The total number of surgical and endovascular interventions was significantly higher in AVGs (p <or=0.05). Access stenosis, thrombosis and infection episodes occurred more frequently in AVG (p = 0.02). VAs had a high rate of interventions. Our study demonstrated better results of AVFs formation over AVGs, for long-term HD access in pediatrics. Surveillance and radiologic procedures are necessary for early detection and treatment of access complications in order to extend access survival.
本研究旨在报告单中心关于慢性血液透析（HD）儿童永久性血管通路（VA）管理和结果的经验。我们分析了 2000 年 1 月至 2008 年 12 月期间 79 例终末期肾病慢性 HD 患儿的永久性 VA 存活率。在 79 例儿童中，共建立了 137 个 VA [89 个原生瘘管（AVF）和 48 个移植物（AVG）]。>25kg 体重的儿童中 AVF 的建立明显更为频繁，而<25kg 体重的儿童中 AVG 的建立更为频繁（p = 0.003）。AVF 的 1 年原发性通畅率为 50%，AVG 的 30%。AVF 的 1、2 和 3 年继发性通畅率分别为 73%、50%和 20%，AVG 分别为 64%、36%和 20%。AVG 的手术和血管内介入总数明显更高（p<0.05）。AVG 更容易发生血管狭窄、血栓形成和感染（p = 0.02）。VA 需要进行大量干预。我们的研究表明，在儿科长期 HD 通路中，AVF 的形成比 AVG 具有更好的结果。需要进行监测和放射学检查，以便早期发现和治疗通路并发症，从而延长通路的生存时间。
