Merouani Aicha, Lallier Michel, Paquet Julie, Gagnon Johanne, Lapeyraque Anne Laure
Pediatric Nephrology, Dialysis Unit, Department of Pediatrics, Sainte Justine Hospital (CHU Sainte-Justine), University of Montreal, 3175 Côte Sainte Catherine, Montreal, QC, H3T 1C5, Canada,
Pediatr Nephrol. 2014 Dec;29(12):2395-401. doi: 10.1007/s00467-014-2877-5. Epub 2014 Aug 8.
The choice of vascular access (VA) for hemodialysis (HD) in end-stage renal disease (ESRD) is arteriovenous fistula (AVF) or central venous catheter (CVC). Whereas clinical practice guidelines suggest AVF to preserve the vascular bed, pediatric nephrologists tend to favor CVC for shorter-term dialysis. Our objective was to determine whether pediatric priority allocation policies for deceased-donor kidneys affect VA planning.
Pediatric priority for deceased-donor kidneys was instituted in Quebec in 2004. We retrospectively compared clinical practice on AVF, CVC, wait time on transplant list, HD duration in pre-policy (group A) and post-policy (group B) from 1997-2011.
We identified 78 patients with a median age of 14.7 years (range, 0.7-20.5 years) and weight of 46 kg (12.5-95 kg); AVF decreased from 76 % in group A to 41 % in group B (p = 0.002). Wait times on transplant list were significantly reduced: median 413.5 days (range, 2-1,910 days) in group A vs. 89 days (range, 18-692 days) in group B (p = 0.003). Time on HD for deceased-donor recipients was shorter: 705 (range, 51-1,965 days) group A vs. 349.5 days (range, 158-1,060 days) group B (p = 0.01).
This is the first study to document VA changes related to pediatric priority allocation policy. Our fistula-first center saw a shift toward CVC-first.
终末期肾病（ESRD）患者进行血液透析（HD）时，血管通路（VA）的选择为动静脉内瘘（AVF）或中心静脉导管（CVC）。虽然临床实践指南建议采用AVF以保护血管床，但儿科肾脏病学家倾向于在短期透析时选择CVC。我们的目的是确定儿童对 deceased-donor 肾脏的优先分配政策是否会影响VA规划。
2004年魁北克开始实施 deceased-donor 肾脏的儿童优先政策。我们回顾性比较了1997年至2011年在政策实施前（A组）和政策实施后（B组）关于AVF、CVC、移植等待时间、HD持续时间的临床实践情况。
我们确定了78例患者，中位年龄为14.7岁（范围0.7 - 20.5岁），体重为46kg（12.5 - 95kg）；AVF的使用率从A组的76%降至B组的41%（p = 0.002）。移植等待时间显著缩短：A组中位等待时间为413.5天（范围2 - 1910天），B组为89天（范围18 - 692天）（p = 0.003）。接受 deceased-donor 肾脏移植患者的HD时间更短：A组为705天（范围51 - 1965天），B组为349.5天（范围158 - 1060天）（p = 0.01）。
这是第一项记录与儿童优先分配政策相关的VA变化的研究。我们的先内瘘中心出现了向先中心静脉导管的转变。
