Abstract
Background
Arteriovenous fistula (AVF) is the preferred access for chronic hemodialysis (HD) in children and adolescents, but central venous catheter use is still high.
Methods
Retrospective chart review of children and adolescents with AVF created between January 2003 and December 2015 was performed to assess primary failure (PF), maturation time, functional primary and functional cumulative patency, and potential risk factors for AVF dysfunction.
Results
Ninety-nine AVF were created in 79 patients (54% male; 7–24 years; 16–147 kg) by experienced surgeons. Duplex ultrasonography vein mapping was used to assist with site selection. PF occurred in 17 AVF (17%) in 14 patients. Patient age, gender, ethnicity, underlying disease, time on dialysis, and AVF site were not associated with PF or patency. Coagulation abnormality was positively associated with PF (p = 0.03). Function was achieved in 82 AVF (83%) in 77 patients (97%). Median maturation time was 83 days (range 32–271). AVF were accessed via buttonholes. Functional primary patency was 95%, 84%, and 53% at 1, 2, and 5 years. Overall 1- and 2-year functional cumulative patency was 95%, but lower for small patients 16–30 kg (88%) and those greater than 80 kg (91%). The 5-year patency rate was 80%, but significantly lower for 16–30 kg (59%) and greater than 80 kg (55%). Risk analysis showed significantly better patency for 31–45 kg and 46–80 kg groups (p < 0.01), non-obese BMI (p = 0.01), and buttonhole self-cannulation (p = 0.03).
Conclusions
This study provides more information about successful AVF with buttonhole cannulation in pediatric hemodialysis patients lending additional support for AVF use in pediatrics.
Graphical abstract
A higher resolution version of the Graphical abstract is available as Supplementary information
Similar content being viewed by others
Data availability
Datasets generated and analyzed during this study are available from the corresponding author upon reasonable request.
Code availability
Not applicable
References
United States Renal Data System (2019) 2018 Annual Data Report. Chapter 7: ESRD among children, adolescents, and young adults. Am J Kidney Dis 73:S463–S500. https://doi.org/10.1053/j.ajkd.2018.12.019
Borzych-Duzalka DSR, Ariceta G, Yap YC, Paglialonga F, Xu H, Kang HG, Thumfart J, Aysun KB, Stefanidis CJ, Fila M, Sever L, Vondrak K, Szabo AJ, Szczepanska M, Ranchin B, Holtta T, Zaloszyc A, Bilge I, Warady BA, Schaefer F, Schmitt CP (2019) Vascular access choice, complications, and outcomes in children on maintenance hemodialysis: findings from the International Pediatric Hemodialysis Network (IPHN) Registry. Am J Kidney Dis 74:193–202. https://doi.org/10.1053/j.ajkd.2019.02.014
Chand DH, Valentini RP, Kamil ES (2009) Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners. Pediatr Nephrol 24:1121–1128. https://doi.org/10.1007/s00467-008-0812-3
Ramage IJ, Bailie A, Tyerman KS, McColl JH, Pollard SG, Fitzpatrick MM (2005) Vascular access survival in children and young adults receiving long-term hemodialysis. Am J Kidney Dis 45:708–714. https://doi.org/10.1053/j.ajkd.2004.12.010
Baracco R, Mattoo T, Jain A, Kapur G, Valentini RP (2014) Reducing central venous catheters in chronic hemodialysis–a commitment to arteriovenous fistula creation in children. Pediatr Nephrol 29:2013–2020. https://doi.org/10.1007/s00467-013-2744-9
Chand DH, Valentini RP (2008) International pediatric fistula first initiative: a call to action. Am J Kidney Dis 51:1016–1024. https://doi.org/10.1053/j.ajkd.2008.02.309
Fadrowski JJ, Hwang W, Neu AM, Fivush BA, Furth SL (2009) Patterns of use of vascular catheters for hemodialysis in children in the United States. Am J Kidney Dis 53:91–98. https://doi.org/10.1053/j.ajkd.2008.08.011
Kim SM, Min SK, Ahn S, Min SI, Ha J (2016) Outcomes of arteriovenous fistula for hemodialysis in pediatric and adolescent patients. Vasc Specialist Int 32:113–118. https://doi.org/10.5758/vsi.2016.32.3.113
Bourquelot P (2006) Vascular access in children: the importance of microsurgery for creation of autologous arteriovenous fistulae. Eur J Vasc Endovasc Surg 32:696–700. https://doi.org/10.1016/j.ejvs.2006.04.010
Karava V, Jehanno P, Kwon T, Deschenes G, Macher MA, Bourquelot P (2018) Autologous arteriovenous fistulas for hemodialysis using microsurgery techniques in children weighing less than 20 kg. Pediatr Nephrol 33:855–862. https://doi.org/10.1007/s00467-017-3854-6
Matoussevitch V, Taylan C, Konner K, Gawenda M, Kuhr K, Hoppe B, Brunkwall J (2015) AV fistula creation in paediatric patients: outcome is independent of demographics and fistula type reducing usage of venous catheters. J Vasc Access 16:382–387. https://doi.org/10.5301/jva.5000395
Peditools. CDC growth calculator for 2 to 20 years. https://peditools.org/growthpedi/. Accessed 6 March 2022
Huynh TTT, Garza BN, Geer J, Broadbent KC, Martinek WA, Correa AM, Swartz SJ, Srivaths P, Brewer ED (2019) The role of pre-operative duplex ultrasound vessel mapping in determining primary failure of pediatric hemodialysis arteriovenous fistula. J Vasc Ultrasound 43:63–68. https://doi.org/10.1177/1544316719831508
Shroff R, Calder F, Bakkaloglu S, Nagler EV, Stuart S, Stronach L, Schmitt CP, Heckert KH, Bourquelot P, Wagner AM, Paglialonga F, Mitra S, Stefanidis CJ, European Society for Paediatric Nephrology Dialysis Working Group (2019) Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group. Nephrol Dial Transplant 34:1746–1765. https://doi.org/10.1093/ndt/gfz011
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Arbreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP (2020) KDOQI clinical practice guideline for vascular access: 2019 Update. Am J Kidney Dis 75:S1–S164. https://doi.org/10.1053/j.ajkd.2019.12.001
Chand DH, Bednarz D, Eagleton M, Krajewski L (2009) A vascular access team can increase AV fistula creation in pediatric ESRD patients: a single center experience. Semin Dial 22:679–683. https://doi.org/10.1111/j.1525-139X.2009.00638.x
Sheth RD, Brandt ML, Brewer ED, Nuchtern JG, Kale AS, Goldstein SL (2002) Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease. Kidney Int 62:1864–1869. https://doi.org/10.1046/j.1523-1755.2002.00630.x
Onder AM, Flynn JT, Billings AA, Deng F, DeFreitas M, Katsoufis C, Grinsell MM, Patterson L, Jetton J, Fathallah-Shaykh S, Ranch D, Aviles D, Copelovitch L, Ellis E, Chadha V, Elmaghrabi A, Lin JJ, Butani L, Haddad M, Marsenic O, Brakeman P, Quigley R, Shin HS, Garro R, Liu H, Rahimikollu J, Raina R, Langman CB, Wood EG, Midwest Pediatric Nephrology Consortium (2020) Predictors of time to first cannulation for arteriovenous fistula in pediatric hemodialysis patients: Midwest Pediatric Nephrology Consortium study. Pediatr Nephrol 35:287–295. https://doi.org/10.1007/s00467-019-04396-3
Onder AM, Flynn JT, Billings AA, Deng F, DeFreitas M, Katsoufis C, Grinsell MM, Patterson LT, Jetton J, Fathallah-Shaykh S, Ranch D, Aviles D, Copelovitch L, Ellis E, Chanda V, Elmaghrabi A, Lin JJ, Butani L, Haddad M, Couloures OM, Brakeman P, Quigley R, Shin HS, Garro R, Liu H, Rahimikollu J, Raina R, Langman CB, Wood EG, Midwest Pediatric Nephrology Consortium (2019) Predictors of patency for arteriovenous fistulae and grafts in pediatric hemodialysis patients. Pediatr Nephrol 34:329–339. https://doi.org/10.1007/s00467-018-4082-4
Jennings WC, Turman MA, Taubman KE (2009) Arteriovenous fistulas for hemodialysis access in children and adolescents using the proximal radial artery inflow site. J Pediatr Surg 44:1377–1381. https://doi.org/10.1016/j.jpedsurg.2008.11.001
Wartman SM, Rosen D, Woo K, Gradman WS, Weaver FA, Rowe V (2014) Outcomes with arteriovenous fistulas in a pediatric population. J Vasc Surg 60:170–175. https://doi.org/10.1016/j.jvs.2014.01.050
Shroff R, Sterenborg RB, Kuchta A, Arnold A, Thomas N, Stronach L, Padayachee S, Calder F (2016) A dedicated vascular access clinic for children on haemodialysis: two years’ experience. Pediatr Nephrol 31:2337–2344. https://doi.org/10.1007/s00467-016-3428-z
Tordoir JC, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Vennegoor M, Wanner C, Wee P, Vanholder R (2007) EBPG on vascular access. Nephrol Dial Transplant 22:ii88–ii117. https://doi.org/10.1093/ndt/gfm021
Lauvao LS, Ihnat DM, Goshima KR, Chavez L, Gruessner AC, Mills JL Sr (2009) Vein diameter is the major predictor of fistula maturation. J Vasc Surg 49:1499–1504. https://doi.org/10.1016/j.jvs.2009.02.018
Allon M, Lockhart ME, Lilly RZ, Gallichio MH, Young CJ, Barker J, Deierhoi MH, Robbin ML (2001) Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 60:2013–2020. https://doi.org/10.1046/j.1523-1755.2001.00031.x
Salmela B, Hartman J, Peltonen S, Alback A, Lassila R (2013) Thrombophilia and arteriovenous fistula survival in ESRD. Clin J Am Soc Nephrol 8:962–968. https://doi.org/10.2215/CJN.03860412
Morgans HA, De Souza HG, Richardson T, Claes D, Barton KT, Lee M, Mahesh S, Muff-Luett M, Swartz SJ, Neu A, Warady B, SCOPE Collaborative (2020) A comparison of the buttonhole and rope-ladder AVF cannulation techniques and infection rates within the SCOPE collaborative. Pediatr Nephrol 36:3915–3921. https://doi.org/10.1007/s00467-021-05137-1
Moore T, Brightman S, Dodson DL, Warady BA (2019) Arteriovenous buttonhole access cannulation in pediatric patients on hemodialysis. Nephrol Nurs J 46:407–411
Wong B, Muneer M, Wiebe N, Storie D, Shurraw S, Pannu N, Klarenbach S, Grudzinski A, Nesrallah G, Pauly RP (2014) Buttonhole versus rope-ladder cannulation of arteriovenous fistulas for hemodialysis: a systematic review. Am J Kidney Dis 64:918–936. https://doi.org/10.1053/j.ajkd.2014.06.018
Lyman M, Nguyen DB, Shugart A, Gruhler H, Lines C, Patel PR (2020) Risk of vascular access infection associated with buttonhole cannulation of fistulas: data from the National Healthcare Safety Network. Am J Kidney Dis 76:82–89. https://doi.org/10.1053/j.ajkd.2019.11.006
Author information
Authors and Affiliations
Contributions
All authors participated in the design of the study and writing the manuscript. B Garza, J Geer, T Huynh, and S Swartz performed data collection. B Garza, P Srivaths, T Huynh and E Brewer participated in data analysis. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study was approved by the Baylor College of Medicine Institutional Review Board and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Baylor College of Medicine Institutional Review Board approved the waiver of consent for this retrospective chart review.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Garza, B., Geer, J., Swartz, S.J. et al. Good outcomes for arteriovenous fistula with buttonhole cannulation for chronic hemodialysis in children and adolescents. Pediatr Nephrol 38, 509–517 (2023). https://doi.org/10.1007/s00467-022-05580-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-022-05580-8