HEMODIALYSIS ACCESS PROCEDURES IN PEDIATRIC PATIENTS WITH END STAGE RENAL DISEASE- OUTCOME ANALYSIS

Background:Arteriovenous fistulae (AVF) are the dialysis access modality of choice for patients with end stage renal disease (ESRD). Many children have poor vein caliber which renders them unsuitable for performing AV fistula and those end up in chronic tunneled hemodialysis catheter. The longer maturation time in children than that in adults and the technical difficulties imposed by small diameters of the vessels are other challenges in operation on pediatric patients. Methods: Data collected from pediatric patients with endstage renal failure in whom HD access procedure was performed retrospectively and followed up and the following data were analyzed. study performed in GovtOmandurar Multi Super SpecialityHospital,Chennai. Affiliated to, TheTamilnaduDr.M.G.R Medical University. Etiology of renal failure, time on dialysis, CKD history, and transplantation and type of HD access procedure, patency and functioning at 6 months for both were recorded. Patients of age 0 to 15 were included in this study, age was the only inclusion criteria. Results: children with growth less than 50th percentile tend to have poor vein caliber with ending in chronic HD catheter. Pre operativeand priorvene puncture was present in (80%) patients in whom further AV fistula was not feasible. Patients with renal failure secondary to obstructive uropathy were favoring creation of AV fistula. Patients with no prior history of ICU admission for volume over load had better feasibility of AVF creation. Average time of HD(Hemo Dialysis) catheter patency in 6 months was 92%. Primary patency of AV fistula was 85% in 6 months. Maturation rates and secondary failure was not evaluated in this study. Conclusion: anatomic factors like vein diameter, prior venepuncture highly influence the type of HD access procedure. at 6 months chronic tunneled catheter had better patency than AV fistula. Proper education of the medical fraternity dealing with pediatric renal failure patients regarding these factor will help in long term functioning of the fistulas and patency of the HD catheter and survival.