Patterns of Use of Vascular Catheters for Hemodialysis in Children in the United States

Fadrowski, Jeffrey J.; Hwang, Wenke; Neu, Alicia M.; Fivush, Barbara A.; Furth, Susan L.

doi:10.1053/j.ajkd.2008.08.011

« Previous Next »American Journal of Kidney Diseases
Volume 53, Issue 1 , Pages 91-98, January 2009

Patterns of Use of Vascular Catheters for Hemodialysis in Children in the United States

Jeffrey J. Fadrowski, MD, MHS
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Address correspondence to Jeffrey J. Fadrowski, MD, MHS, David M. Rubenstein Child Health Bldg, Rm 3055, 200 N Wolfe St, Baltimore, MD 21287
Wenke Hwang, PhD
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
Alicia M. Neu, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
Barbara A. Fivush, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
Susan L. Furth, MD, PhD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD

Received 10 April 2008; accepted 4 August 2008. published online 28 October 2008.

Background

Arteriovenous fistulas (AVFs) and grafts (AVGs) have been associated with improved clinical outcomes in children and adults with end-stage renal disease (ESRD) on maintenance hemodialysis (HD) therapy, but use of vascular catheters is high. Identifying the reasons for the high prevalence of vascular catheters in children on HD therapy is necessary to assess whether targeted interventions may increase the prevalence of AVFs/AVGs.

Study Design

Retrospective cohort study.

Setting & Participants

Children younger than 18 years on HD therapy in the 2001 to 2003 ESRD Clinical Performance Measures (CPM) Projects followed up in the US Renal Data System transplant files through December 31, 2004.

Predictor

Vascular access type and reasons for use of a vascular catheter.

Outcomes & Measurements

Demographic/clinical characteristics, including the reason provided for use of a vascular catheter, and the association of type of vascular access and (1) patient size and (2) time to kidney transplantation.

Results

Of 1,284 prevalent pediatric CPM patients examined, 529 (41%) had an AVF/AVG and 755 (59%) had a vascular catheter. Of 755 children with a catheter, “small body size” was a commonly listed reason (N = 142); 49% of these children weighed 20 kg or more. Of 53 patients with catheters described as having an “AVF/AVG maturing” and present in the consecutive ESRD CPM project year, 64% had a functioning AVF/AVG the following year. For those with “transplantation scheduled” listed as a reason for a vascular catheter (N = 83), 69% underwent transplantation within 1 year, and median time to transplantation was 115 days. Of all children with vascular catheters (N = 755), 32.2% underwent transplantation within 1 year, and median time to transplantation was 264 days compared with 21.7% and 347 days for those with AVFs/AVGs, respectively (N = 529). Of the 445 incident children in this cohort, 89% had a vascular catheter at dialysis therapy initiation.

Limitations

Because of study design, only associations can be described.

Conclusions

Vascular catheter use in children on HD therapy is high. This is partially explained by expeditious transplantation and technical barriers to AVF/AVG placement in small children; however, only one-third of patients with a vascular catheter underwent transplantation within 1 year. Interventions to decrease vascular catheter use in this population may be necessary.

Index Words: Pediatric, end-stage renal disease, hemodialysis, vascular access, vascular catheter, transplantation