Comparison of vascular access type in pediatric hemodialysis patients with respect to urea clearance, anemia management, and serum albumin concentration

Background: Central venous catheters (CVCs) remain the most common vascular access in pediatric hemodialysis patients. Risks for infection and dysfunction are greatest among patients using CVCs as opposed to those with arteriovenous fistulae (AVFs) and arteriovenous grafts (AVGs). Studies of adult hemodialysis patients show greater morbidity and mortality in patients with a CVC. The study goal is to determine whether hemodialysis access in pediatric patients influences urea clearance (Kt/V and urea reduction rate [URR]), anemia management (hemoglobin [Hgb] concentration and recombinant human erythropoietin [rHuEPO] use), and serum albumin levels. Methods: Data were abstracted from The Renal Network, Inc, Data System for pediatric patients with identified hemodialysis access from 2000 to 2002. Data were subdivided according to age: 0 to 5, 6 to 10, 11 to 15, and 16 to 18 years. Univariate analysis of variance was performed on Kt/V, URR, serum albumin concentration, Hgb concentration, and rHuEPO dose. Results: There were 601 recorded observations in 140 patients (90 males and 50 females). There were 56 Caucasians and 73 African Americans. Comparing Kt/V and URR, adjusting for blood flow and treatment times, a difference between AVFs and AVGs compared with CVCs was seen. Mean Hgb concentration was lower in patients with a CVC. Mean rHuEPO dose was greatest in patients using a CVC, and mean albumin level was lower for patients using a CVC. Conclusion: In children, hemodialysis using an AVF or AVG improves outcome in relation to urea clearance, Hgb concentration, and serum albumin level. Efforts to reduce CVC use should be extended to the pediatric dialysis population.