Hemodialysis vascular access in children

Vascular access has been heralded as the backbone to the provision of dialysis, and in children poses unique challenges to the pediatric dialysis care provider due to smaller vessel diameters and vascular hyperreactivity. Whether in the face of acute kidney injury (AKI) requiring renal replacement therapy (RRT) or as a result of chronic –kidney disease (CKD), children should not be considered “little adults.” Further, a critical issue for these patients is to provide adequate vascular access for current RRT requirements without compromising future potential access sites. Because this requires a different surgical philosophy, it is important to develop a team composed of surgeons, pediatric nephrologists, and dialysis nurses interested in these unique challenges. This chapter will provide a basic overview of pediatric vascular access creation and maintenance including surgical and medical nuances.