Abstract

Pediatric patients with end stage renal disease (ESRD) require hemodialysis for survival, of which Arteriovenous fistulae (AVF) is the access modality of choice. Physicians reluctance to the AVF creation in children include high primary failure rates, longer maturation time, small diameters of the vessels. Predicting the factors for early failure can reduce the morbidity of multiple surgeries for access creation. Methods: Data analysed included etiology of renal failure, weight, sex, age, time on dialysis, Central Venous Catheterisation (CVC) history, and transplantation history. Pediatric age 5 to 15 were included in this study, age was the only inclusion criteria. Results: Previous vein puncture of the access vein was present in (80%) patients with primary failure. Greater than one previous access failure had higher probability of failure. No previous hemodialysis was predictive of early failure. Perioperative factors included, poor vein distension (<2mm) during procedure and absence of spiral laminar flow post-operative Doppler examination also predicted early failure in 100% of the patients. Conclusion: Anatomic factors like vein distension, prior venipuncture highly influence the patency rates. Anemia, hypertension and HD benefitted in maintaining patency. 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 survival.

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