Division of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria.
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.
Pediatr Nephrol. 2019 Apr;34(4):713-721. doi: 10.1007/s00467-018-4129-6. Epub 2018 Dec 26.
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.
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.
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.
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.
目前的指南主张对于开始血液透析（HD）的儿童，使用动静脉瘘（AVF）而不是中心静脉导管（CVC）。有关当前实践、血管通路选择和转换的决定因素、患者生存率以及移植通路的欧洲数据有限。
我们纳入了 18 个欧洲国家的起始 HD 患者，他们于 2000 年至 2013 年期间接受 HD 治疗，血管通路类型向 ESPN/ERA-EDTA 登记处报告。使用描述性统计、逻辑回归和 Cox 回归模型以及累积发病率竞争风险分析评估数据。
393 例（55.1%）713 例儿童开始 HD 时使用 CVC，且更常为女性、年龄更小、更常为未知诊断、肾小球肾炎或血管炎，以及血红蛋白和 HD 起始时身高-SDS 更低。AVF 患者转换为第二种通路的可能性低 91%，两年患者生存率为 99.6%（CVC 为 97.2%）。起始时使用 AVF 的儿童接受活体供体移植的可能性较小（调整后的 HR，0.30；95%CI，0.16-0.54），接受已故供体移植的可能性较大（调整后的 HR，1.50；95%CI，1.17-1.93），即使在排除了前 6 个月死亡或移植的患者后也是如此。
CVC 仍然是欧洲开始 HD 的儿童最常见的血管通路类型。我们的结果表明，CVC 的选择受到转诊时间、终末期肾病的快速发作、年龄较小以及预期较短的移植时间的影响。血管通路类型对随后移植中活体和已故供体之间捐赠模式的影响需要进一步研究。
