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

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

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)91-98
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume53
Issue number1
DOIs
StatePublished - Jan 1 2009

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Vascular Access Devices
Renal Dialysis
Arteriovenous Fistula
Transplantation
Transplants
Chronic Kidney Failure
Blood Vessels
Catheters
Therapeutics
Body Size
Information Systems
Kidney Transplantation
Dialysis
Cohort Studies
Retrospective Studies
Maintenance
Demography

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Fadrowski, Jeffrey J. ; Hwang, Wenke ; Neu, Alicia M. ; Fivush, Barbara A. ; Furth, Susan L. / Patterns of Use of Vascular Catheters for Hemodialysis in Children in the United States. In: American Journal of Kidney Diseases. 2009 ; Vol. 53, No. 1. pp. 91-98.
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abstract = "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.",
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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.

In: American Journal of Kidney Diseases, Vol. 53, No. 1, 01.01.2009, p. 91-98.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Patterns of Use of Vascular Catheters for Hemodialysis in Children in the United States

AU - Fadrowski, Jeffrey J.

AU - Hwang, Wenke

AU - Neu, Alicia M.

AU - Fivush, Barbara A.

AU - Furth, Susan L.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - 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.

AB - 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.

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