Accesos vasculares para hemodiálisis crónica en niños / Vascular accesses for hemodialysis in children

RESUMO

Background: The success of a chronic hemodialysis program depends on a good vascular access. Aim: To evaluate the experience with vascular accesses for chronic hemodialysis in pediatric patients. Patients and methods: One hundred fifty one vascular accesses used in 60 pediatric patients (33 female) coming from 2 hemodialysis (HD) centers were analyzed. Results: The average age of admission to the hemodialysis program was 10 years old (range 1.8-15). Forty percent of accesses were internal arterio-venous fistulae (AVF), 58 percent were central venous catheters and 2 percent were grafts. Twenty four patients required a central venous catheter from the beginning since they required immediate dialysis. Twenty patients began dialysis with a permeable AVF and never required another vascular access. Eight small children used a central catheter as the only vascular access and 32 patients required both types of vascular accesses. Eighty seven catheters were used in 34 patients, of which 77 were temporary and 10 permanent. Seventeen patients needed only one catheter and one girl required 15 catheters. The average life span for AVF was 524 days (20-1277), for temporary catheters 34 days (1-76) and for permanent catheters 73 days (9-147). Two years survival of AVF was 95 percent. One month survival for subclavian and jugular catheters was 50 percent. Fifty six percent of AVF had no complications, 12 failed due to insufficient flow and 24 percent had a complication. Of the 87 catheters placed, 75 percent had complications and 22 were electively removed. Conclusions: Arteriovenous fistula is the vascular access of choice for hemodialysis in pediatric patients. Central venous catheters can become an essential access, specially in small children