Clinical Nephrology, Volume 96 (2021) - November (270 - 280)

Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study

Ali Mirza Onder1, Joseph T. Flynn2, Md Abu Yusuf Ansari4, Fang Deng5, Marissa DeFreitas6, Chryso Katsoufis6, Matthew M. Grinsell7, Larry Patterson8, Jennifer Jetton9, Sahar Fathallah-Shaykh10, Daniel Ranch11, Diego Aviles12, Lawrence Copelovitch13, Eileen Ellis14, Vimal Chadha15, Ayah Elmaghrabi16, Jen-Jar Lin17, Lavjay Butani18, Maha Haddad18, Olivera Marsenic19, Paul Brakeman20, Raymond Quigley16, H. Stella Shin21, Rouba Garro21, Rupesh Raina22, Craig B. Langman5, Ellen Wood3, on behalf of the Pediatric Nephrology Research Consortium
1 Division of Pediatric Nephrology, Batson Children’s Hospital of Mississippi, University of Mississippi, Jackson, MS, 2 Division of Nephrology, Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, 3 Department of Pediatrics, Division of Pediatric Nephrology, SSM Cardinal Glennon Children’s Hospital, Saint Louis University, St. Louis, MO, 4 Department of Data Science, University of Mississippi Medical Center, Jackson, MS, 5 Kidney Diseases Division, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, 6 Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children’s Hospital, University of Miami Leonard M Miller School of Medicine, Miami, FL, 7 Division of Pediatric Nephrology, Primary Children’s Hospital, University of Utah, Salt Lake City, UT, 8 Division of Pediatric Nephrology, Children’s National Health System, Washington, DC, 9 Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, 1  0 Division of Pediatric Nephrology, Children’s of Alabama, University of Alabama, Birmingham, AL, 1  1 Division of Pediatric Nephrology, University of Texas Health Science Center, San Antonio, TX, 1  2 Division of Pediatric Nephrology, Children’s Hospital New Orleans, LSU Heath School of Medicine, New Orleans, LA, 1  3 Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, 1  4 Division of Pediatric Nephrology, Arkansas Children’s Hospital, Little Rock, AR, 1  5 Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, MO, 1  6 Division of Pediatric Nephrology, Children’s Medical Center Dallas, UT Southwestern, Dallas, TX, 1  7 Division of Pediatric Nephrology, Brenner Children’s Hospital, Wake Forest University, Winston Salem, NC, 1  8 Division of Pediatric Nephrology, UC Davis Children’s Hospital, Sacramento, CA, 1  9 Division of Pediatric Nephrology, Lucile Packard Children’s Hospital, Stanford University School of Medicine, 2  0 Division of Pediatric Nephrology, UCSF Benioff Children’s Hospital, San Francisco, CA, 2  1 Division of Pediatric Nephrology, Children’s Healthcare of Atlanta, Atlanta, GA, and 2  2 Division of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, USA

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DOI 10.5414/CN110455

Abstract

Background and objectives: Arteriovenous fistulae (AVF) and grafts (AVG) are preferred permanent vascular access (PVA) for chronic hemodialysis (HD) patients. Our objective was to examine the change in markers of HD efficacy after successful establishment of a PVA among children who started HD with a tunneled cuffed catheter (TCC).
Materials and methods: Retrospective chart reviews were completed on patients from 20 pediatric dialysis centers. All patients used TCC prior to AVF/AVG, and each patient acted as his/her own control. Data on markers of HD efficacy (single-pool Kt/V, urea reduction ratio (URR), serum albumin and hematocrit (Hct)) were collected at the creation of AVF/AVG and for 2 years thereafter. Statistical methods included hypothesis testing and statistical modeling after adjusting for relevant demographic variables.
Results: First PVA was created in 98 individual children: 87 (89%) were AVF and 11 (11%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4 ± 17.3 months. At 1-year follow-up, Kt/V improved by 0.15 ± 0.06 (p = 0.02) and URR improved by 4.54 ± 1.17% (p < 0.0001). Furthermore, PVA was associated with improved serum albumin by 0.31 ± 0.07 g/dL (p < 0.0001) and Hct by 2.80 ± 0.65% (p < 0.0001) at 1 year. These HD efficacy markers remained statistically significant at 2nd-year follow-up. These observations were further supported by the adjusted models. Conversion to AVF was associated with statistically significant improvement in all four markers of HD efficacy at 1-year follow-up. This trend was not demonstrated for subjects who were converted to AVG.
Conclusion: Switching to PVA was associated with improved markers of HD efficacy, single-pool Kt/V, URR, serum albumin, and Hct. This improvement was mostly demonstrated at 1year and maintained for the 2nd year. The potential differential impact of the type of PVA on the trajectory of markers of HD efficacy should be further investigated.

Author Details

Authors

Departments

  • 1 Division of Pediatric Nephrology, Batson Children’s Hospital of Mississippi, University of Mississippi, Jackson, MS,
  • 2 Division of Nephrology, Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,
  • 3 Department of Pediatrics, Division of Pediatric Nephrology, SSM Cardinal Glennon Children’s Hospital, Saint Louis University, St. Louis, MO,
  • 4 Department of Data Science, University of Mississippi Medical Center, Jackson, MS,
  • 5 Kidney Diseases Division, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL,
  • 6 Department of Pediatrics, Division of Pediatric Nephrology, Holtz Children’s Hospital, University of Miami Leonard M Miller School of Medicine, Miami, FL,
  • 7 Division of Pediatric Nephrology, Primary Children’s Hospital, University of Utah, Salt Lake City, UT,
  • 8 Division of Pediatric Nephrology, Children’s National Health System, Washington, DC,
  • 9 Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children’s Hospital, Iowa City, IA,
  • 1 
  • 0 Division of Pediatric Nephrology, Children’s of Alabama, University of Alabama, Birmingham, AL,
  • 1 
  • 1 Division of Pediatric Nephrology, University of Texas Health Science Center, San Antonio, TX,
  • 1 
  • 2 Division of Pediatric Nephrology, Children’s Hospital New Orleans, LSU Heath School of Medicine, New Orleans, LA,
  • 1 
  • 3 Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA,
  • 1 
  • 4 Division of Pediatric Nephrology, Arkansas Children’s Hospital, Little Rock, AR,
  • 1 
  • 5 Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, MO,
  • 1 
  • 6 Division of Pediatric Nephrology, Children’s Medical Center Dallas, UT Southwestern, Dallas, TX,
  • 1 
  • 7 Division of Pediatric Nephrology, Brenner Children’s Hospital, Wake Forest University, Winston Salem, NC,
  • 1 
  • 8 Division of Pediatric Nephrology, UC Davis Children’s Hospital, Sacramento, CA,
  • 1 
  • 9 Division of Pediatric Nephrology, Lucile Packard Children’s Hospital, Stanford University School of Medicine,
  • 2 
  • 0 Division of Pediatric Nephrology, UCSF Benioff Children’s Hospital, San Francisco, CA,
  • 2 
  • 1 Division of Pediatric Nephrology, Children’s Healthcare of Atlanta, Atlanta, GA, and
  • 2 
  • 2 Division of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, USA

Address


Ali Mirza Onder, MD

Batson Children’s ­Hospital of Mississippi
University of Mississippi Medical Center
Division of Pediatric Nephrology
2500 North State Street, Jackson, MS 39216, USA
Email: [email protected]

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Citation

Ali Mirza Onder, Joseph T Flynn, Md Abu Yusuf Ansari, Fang Deng, Marissa DeFreitas, Chryso Katsoufis, Matthew M Grinsell, Larry Patterson, Jennifer Jetton, Sahar Fathallah-Shaykh, Daniel Ranch, Diego Aviles, Lawrence Copelovitch, Eileen Ellis, Vimal. Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study
. Clin Nephrol. 2021; 96: 270-280. doi: 10.5414/CN110455. Pubmed: https://pubmed.ncbi.nlm.nih.gov/34190683/; PMID: 34190683.

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