Outcomes of arteriovenous fistula for hemodialysis in pediatric age group

INTRODUCTION: The feasibility of arteriovenous fistula (AVF) creation in pediatric patients has long been documented, but few studies have evaluated the forms and long-term outcomes. The aim of this article is to highlight the types, techniques and outcomes of AVFs in pediatric age group. METHODS: This is multi-center, retrospective, single cohort study, including all the cases of pediatric (less than 18 year old) cases underwent AVF creation during four years (2015–2019). The following data were obtained from the patients' medical records and analyzed; socio-demographics, etiology of renal failure (RF), history of dialysis and transplantation, type and site of AVF, the outcomes and complications. RESULTS: The study included 108 patients, 89 patients (82.4%) were female. The mean age was 13 years. The most common cause of RF was the urological causes which were found in 34 cases (31.5%), followed by nephrotic syndrome (32 cases, 29.6%), glomerulonephritis (27 cases, 25%), and polycystic kidney disease (12 cases, 11.1%). The decision for choosing access site was performed only by clinical examination in 96 patients (88.9%) while duplex ultrasound was requested for 12 cases (11.1%). The operation was done under local anesthesia in 81 cases (75%) and general anesthesia in 27 cases (25%). The procedure was performed in the wrist in 58 cases (53.7%) and in cubital fossa in 50 cases (46.2%). The most common early complication was hematoma (12 cases, 11.1%), followed by ecchymosis (10 cases, 9.3%), infection (8, 7.4%), seroma (4, 3.7%) and thrombosis (3, 2.8%). The one-year primary patency rate was found in 95 patients (88%) and two-year patency rate in 86 patients (79.6%). CONCLUSION: Native AVF in pediatric is the first choice dialysis access even in pediatric population. Radiocephalic in the non-dominant hand is the most preferred site.