Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study

Ali Mirza Onder; Joseph T. Flynn; Md Abu Yusuf Ansari; Fang Deng; Marissa DeFreitas; Chryso Katsoufis; Matthew M. Grinsell; Larry Patterson; Jennifer Jetton; Sahar Fathallah-Shaykh; Daniel Ranch; Diego Aviles; Lawrence Copelovitch; Eileen Ellis; Vimal Chadha; Ayah Elmaghrabi; Jen Jar Lin; Lavjay Butani; Maha Haddad; Olivera Marsenic; Paul Brakeman; Raymond Quigley; H. Stella Shin; Rouba Garro; Rupesh Raina; Craig B. Langman; Ellen Wood

doi:10.5414/CN110455

Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study

Ali Mirza Onder
, Joseph T. Flynn
, Md Abu Yusuf Ansari
, Fang Deng
, Marissa DeFreitas
, Chryso Katsoufis
, Matthew M. Grinsell
, Larry Patterson
, Jennifer Jetton
, Sahar Fathallah-Shaykh
, Daniel Ranch
, Diego Aviles
, Lawrence Copelovitch
, Eileen Ellis
, Vimal Chadha
, Ayah Elmaghrabi
, Jen Jar Lin
, Lavjay Butani
, Maha Haddad
, Olivera Marsenic

Paul Brakeman, Raymond Quigley, H. Stella Shin, Rouba Garro, Rupesh Raina, Craig B. Langman, Ellen Wood

University of Mississippi
University of Washington
Northwestern University
University of Miami
Primary Children's Medical Center
Children's National Medical Center
University of Iowa
University of Alabama at Birmingham
University of Texas Health Science Center at San Antonio
Children's Hospital New Orleans
The Children's Hospital of Philadelphia
University of Arkansas for Medical Sciences
Children's Mercy Hospitals and Clinics
University of Texas Southwestern Medical Center
Wake Forest University
University of California at Davis
Stanford University
University of California at San Francisco
Children's Healthcare of Atlanta
Akron Children's Hospital
Saint Louis University

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background and objectives: Arteriovenous fistulae (AVF) and grafts (AVG) are preferred permanent vascular access (PVA) for chronic hemodialysis (HD) patients. Our objective was to examine the change in markers of HD efficacy after successful establishment of a PVA among children who started HD with a tunneled cuffed catheter (TCC). Materials and methods: Retrospective chart reviews were completed on patients from 20 pediatric dialysis centers. All patients used TCC prior to AVF/AVG, and each patient acted as his/her own control. Data on markers of HD efficacy (single-poolKt/V, urea reduction ratio (URR), serum albumin and hematocrit (Hct)) were collected at the creation of AVF/AVG and for 2 years thereafter. Statistical methods included hypothesis testing and statistical modeling after adjusting for relevant demographic variables. Results: First PVA was created in 98 individual children: 87 (89%) were AVF and 11 (11%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4 ± 17.3 months. At 1-year follow-up, Kt/V improved by 0.15 ± 0.06 (p = 0.02) and URR improved by 4.54 ± 1.17% (p < 0.0001). Furthermore, PVA was associated with improved serum albumin by 0.31 ± 0.07 g/dL (p < 0.0001) and Hct by 2.80 ± 0.65% (p < 0.0001) at 1 year. These HD efficacy markers remained statistically significant at 2nd-year follow-up. These observations were further supported by the adjusted models. Conversion to AVF was associated with statistically significant improvement in all four markers of HD efficacy at 1-year follow-up. This trend was not demonstrated for subjects who were converted to AVG. Conclusion: Switching to PVA was associated with improved markers of HD efficacy, single-pool Kt/V, URR, serum albumin, and Hct. This improvement was mostly demonstrated at 1year and maintained for the 2nd year. The potential differential impact of the type of PVA on the trajectory of markers of HD efficacy should be further investigated.

Original language	English
Pages (from-to)	270-280
Number of pages	11
Journal	Clinical Nephrology
Volume	96
Issue number	5
DOIs	https://doi.org/10.5414/CN110455
State	Published - Nov 2021
Externally published	Yes

Keywords

Albumin
Arteriovenous fistula
Arteriovenous graft
Hematocrit
Hemodialysis efficacy
Kt/V
Urea reduction ratio (URR)

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10.5414/CN110455

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Onder, A. M., Flynn, J. T., Ansari, M. A. Y., Deng, F., DeFreitas, M., Katsoufis, C., Grinsell, M. M., Patterson, L., Jetton, J., Fathallah-Shaykh, S., Ranch, D., Aviles, D., Copelovitch, L., Ellis, E., Chadha, V., Elmaghrabi, A., Lin, J. J., Butani, L., Haddad, M., ... Wood, E. (2021). Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study. Clinical Nephrology, 96(5), 270-280. https://doi.org/10.5414/CN110455

@article{1b938e27f6d2423baa35c84fd3a3129b,

title = "Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study",

abstract = "Background and objectives: Arteriovenous fistulae (AVF) and grafts (AVG) are preferred permanent vascular access (PVA) for chronic hemodialysis (HD) patients. Our objective was to examine the change in markers of HD efficacy after successful establishment of a PVA among children who started HD with a tunneled cuffed catheter (TCC). Materials and methods: Retrospective chart reviews were completed on patients from 20 pediatric dialysis centers. All patients used TCC prior to AVF/AVG, and each patient acted as his/her own control. Data on markers of HD efficacy (single-poolKt/V, urea reduction ratio (URR), serum albumin and hematocrit (Hct)) were collected at the creation of AVF/AVG and for 2 years thereafter. Statistical methods included hypothesis testing and statistical modeling after adjusting for relevant demographic variables. Results: First PVA was created in 98 individual children: 87 (89\%) were AVF and 11 (11\%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4 ± 17.3 months. At 1-year follow-up, Kt/V improved by 0.15 ± 0.06 (p = 0.02) and URR improved by 4.54 ± 1.17\% (p < 0.0001). Furthermore, PVA was associated with improved serum albumin by 0.31 ± 0.07 g/dL (p < 0.0001) and Hct by 2.80 ± 0.65\% (p < 0.0001) at 1 year. These HD efficacy markers remained statistically significant at 2nd-year follow-up. These observations were further supported by the adjusted models. Conversion to AVF was associated with statistically significant improvement in all four markers of HD efficacy at 1-year follow-up. This trend was not demonstrated for subjects who were converted to AVG. Conclusion: Switching to PVA was associated with improved markers of HD efficacy, single-pool Kt/V, URR, serum albumin, and Hct. This improvement was mostly demonstrated at 1year and maintained for the 2nd year. The potential differential impact of the type of PVA on the trajectory of markers of HD efficacy should be further investigated.",

keywords = "Albumin, Arteriovenous fistula, Arteriovenous graft, Hematocrit, Hemodialysis efficacy, Kt/V, Urea reduction ratio (URR)",

author = "Onder, \{Ali Mirza\} and Flynn, \{Joseph T.\} and Ansari, \{Md Abu Yusuf\} and Fang Deng and Marissa DeFreitas and Chryso Katsoufis and Grinsell, \{Matthew M.\} and Larry Patterson and Jennifer Jetton and Sahar Fathallah-Shaykh and Daniel Ranch and Diego Aviles and Lawrence Copelovitch and Eileen Ellis and Vimal Chadha and Ayah Elmaghrabi and Lin, \{Jen Jar\} and Lavjay Butani and Maha Haddad and Olivera Marsenic and Paul Brakeman and Raymond Quigley and Shin, \{H. Stella\} and Rouba Garro and Rupesh Raina and Langman, \{Craig B.\} and Ellen Wood",

note = "Publisher Copyright: {\textcopyright} 2021 Dustri-Verlag Dr. K. Feistle.",

year = "2021",

month = nov,

doi = "10.5414/CN110455",

language = "English",

volume = "96",

pages = "270--280",

journal = "Clinical Nephrology",

issn = "0301-0430",

publisher = "Dustri-Verlag Dr. Karl Feistle",

number = "5",

}

Onder, AM, Flynn, JT, Ansari, MAY, Deng, F, DeFreitas, M, Katsoufis, C, Grinsell, MM, Patterson, L, Jetton, J, Fathallah-Shaykh, S, Ranch, D, Aviles, D, Copelovitch, L, Ellis, E, Chadha, V, Elmaghrabi, A, Lin, JJ, Butani, L, Haddad, M, Marsenic, O, Brakeman, P, Quigley, R, Shin, HS, Garro, R, Raina, R, Langman, CB & Wood, E 2021, 'Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study', Clinical Nephrology, vol. 96, no. 5, pp. 270-280. https://doi.org/10.5414/CN110455

TY - JOUR

T1 - Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children

T2 - Pediatric nephrology research consortium study

AU - Onder, Ali Mirza

AU - Flynn, Joseph T.

AU - Ansari, Md Abu Yusuf

AU - Deng, Fang

AU - DeFreitas, Marissa

AU - Katsoufis, Chryso

AU - Grinsell, Matthew M.

AU - Patterson, Larry

AU - Jetton, Jennifer

AU - Fathallah-Shaykh, Sahar

AU - Ranch, Daniel

AU - Aviles, Diego

AU - Copelovitch, Lawrence

AU - Ellis, Eileen

AU - Chadha, Vimal

AU - Elmaghrabi, Ayah

AU - Lin, Jen Jar

AU - Butani, Lavjay

AU - Haddad, Maha

AU - Marsenic, Olivera

AU - Brakeman, Paul

AU - Quigley, Raymond

AU - Shin, H. Stella

AU - Garro, Rouba

AU - Raina, Rupesh

AU - Langman, Craig B.

AU - Wood, Ellen

PY - 2021/11

Y1 - 2021/11

N2 - Background and objectives: Arteriovenous fistulae (AVF) and grafts (AVG) are preferred permanent vascular access (PVA) for chronic hemodialysis (HD) patients. Our objective was to examine the change in markers of HD efficacy after successful establishment of a PVA among children who started HD with a tunneled cuffed catheter (TCC). Materials and methods: Retrospective chart reviews were completed on patients from 20 pediatric dialysis centers. All patients used TCC prior to AVF/AVG, and each patient acted as his/her own control. Data on markers of HD efficacy (single-poolKt/V, urea reduction ratio (URR), serum albumin and hematocrit (Hct)) were collected at the creation of AVF/AVG and for 2 years thereafter. Statistical methods included hypothesis testing and statistical modeling after adjusting for relevant demographic variables. Results: First PVA was created in 98 individual children: 87 (89%) were AVF and 11 (11%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4 ± 17.3 months. At 1-year follow-up, Kt/V improved by 0.15 ± 0.06 (p = 0.02) and URR improved by 4.54 ± 1.17% (p < 0.0001). Furthermore, PVA was associated with improved serum albumin by 0.31 ± 0.07 g/dL (p < 0.0001) and Hct by 2.80 ± 0.65% (p < 0.0001) at 1 year. These HD efficacy markers remained statistically significant at 2nd-year follow-up. These observations were further supported by the adjusted models. Conversion to AVF was associated with statistically significant improvement in all four markers of HD efficacy at 1-year follow-up. This trend was not demonstrated for subjects who were converted to AVG. Conclusion: Switching to PVA was associated with improved markers of HD efficacy, single-pool Kt/V, URR, serum albumin, and Hct. This improvement was mostly demonstrated at 1year and maintained for the 2nd year. The potential differential impact of the type of PVA on the trajectory of markers of HD efficacy should be further investigated.

AB - Background and objectives: Arteriovenous fistulae (AVF) and grafts (AVG) are preferred permanent vascular access (PVA) for chronic hemodialysis (HD) patients. Our objective was to examine the change in markers of HD efficacy after successful establishment of a PVA among children who started HD with a tunneled cuffed catheter (TCC). Materials and methods: Retrospective chart reviews were completed on patients from 20 pediatric dialysis centers. All patients used TCC prior to AVF/AVG, and each patient acted as his/her own control. Data on markers of HD efficacy (single-poolKt/V, urea reduction ratio (URR), serum albumin and hematocrit (Hct)) were collected at the creation of AVF/AVG and for 2 years thereafter. Statistical methods included hypothesis testing and statistical modeling after adjusting for relevant demographic variables. Results: First PVA was created in 98 individual children: 87 (89%) were AVF and 11 (11%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4 ± 17.3 months. At 1-year follow-up, Kt/V improved by 0.15 ± 0.06 (p = 0.02) and URR improved by 4.54 ± 1.17% (p < 0.0001). Furthermore, PVA was associated with improved serum albumin by 0.31 ± 0.07 g/dL (p < 0.0001) and Hct by 2.80 ± 0.65% (p < 0.0001) at 1 year. These HD efficacy markers remained statistically significant at 2nd-year follow-up. These observations were further supported by the adjusted models. Conversion to AVF was associated with statistically significant improvement in all four markers of HD efficacy at 1-year follow-up. This trend was not demonstrated for subjects who were converted to AVG. Conclusion: Switching to PVA was associated with improved markers of HD efficacy, single-pool Kt/V, URR, serum albumin, and Hct. This improvement was mostly demonstrated at 1year and maintained for the 2nd year. The potential differential impact of the type of PVA on the trajectory of markers of HD efficacy should be further investigated.

KW - Albumin

KW - Arteriovenous fistula

KW - Arteriovenous graft

KW - Hematocrit

KW - Hemodialysis efficacy

KW - Kt/V

KW - Urea reduction ratio (URR)

UR - https://www.scopus.com/pages/publications/85117682267

U2 - 10.5414/CN110455

DO - 10.5414/CN110455

M3 - Article

C2 - 34190683

AN - SCOPUS:85117682267

SN - 0301-0430

VL - 96

SP - 270

EP - 280

JO - Clinical Nephrology

JF - Clinical Nephrology

IS - 5

ER -

Conversion to permanent vascular access is associated with improved markers of hemodialysis efficacy in children: Pediatric nephrology research consortium study

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Keywords

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