Çakıcı Evrim Kargın, Çakıcı Mehmet, Gümüş Fatih, Tan Kürklü Türkan Seda, Yazılıtaş Fatma, Örün Utku Arman, Bülbül Mehmet
Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey.
J Vasc Access. 2020 Sep;21(5):658-664. doi: 10.1177/1129729819897454. Epub 2020 Jan 10.
This study aimed to investigate the complication frequency and the changes in right heart geometry with different access types in the pediatric population.
We included 32 consecutive patients aged between 10 and 19 and who underwent hemodialysis sessions via permanent hemodialysis catheter (n = 18) or arterio-venous fistula (n = 14) between January 2013 and March 2018. We recorded and compared the complication frequency and the changes in echocardiography findings with different access types.
Demographic data were similar in both groups. Number of new access creation (n = 15 vs n = 1) and all complications (n = 19 vs n = 6) were significantly higher in hemodialysis catheter group and the statistical analysis showed the superiority of arterio-venous fistula group in comparison of event-free survival (event-free patients; n = 8 (57%), n = 3 (16%); p = 0.02). Control echocardiography showed impressive delta-change in right atrium diameter (p = 0.04), right ventricular end-diastolic volume (p = 0.004), right ventricular end-systolic volume (p < 0.001), and right ventricular free wall thickness (p = 0.009) in arterio-venous fistula group, but no significant difference between two groups in terms of delta-change of right ventricular ejection fraction (p = 0.35), fractional area change (p = 0.21), and tricuspid annular plane systolic excursion (p = 0.13) parameters.
Arterio-venous fistula has lower risk of complications, but overloading stress on right heart chambers triggers remodeling process and geometrical changes, which can be early pieces of evidence of delayed right heart dysfunction in pediatric hemodialysis patients.
本研究旨在调查儿科人群中不同通路类型的并发症发生率以及右心几何结构的变化。
我们纳入了32例年龄在10至19岁之间的连续患者，这些患者在2013年1月至2018年3月期间通过永久性血液透析导管（n = 18）或动静脉内瘘（n = 14）进行血液透析治疗。我们记录并比较了不同通路类型的并发症发生率以及超声心动图检查结果的变化。
两组的人口统计学数据相似。血液透析导管组的新通路创建数量（n = 15 vs n = 1）和所有并发症数量（n = 19 vs n = 6）显著更高，统计分析显示动静脉内瘘组在无事件生存期方面具有优势（无事件患者；n = 8（57%），n = 3（16%）；p = 0.02）。对照超声心动图显示动静脉内瘘组右心房直径（p = 0.04）、右心室舒张末期容积（p = 0.004）、右心室收缩末期容积（p < 0.001）和右心室游离壁厚度（p = 0.009）有显著的变化，但两组在右心室射血分数变化（p = 0.35）、面积变化分数（p = 0.21）和三尖瓣环平面收缩期位移（p = 0.13）参数的变化方面无显著差异。
动静脉内瘘的并发症风险较低，但右心腔的负荷过重会引发重塑过程和几何结构变化，这可能是儿科血液透析患者右心功能延迟受损的早期证据。
