Acesso vascular em crianças e adolescentes com doença renal crônica em tratamento hemodialítico: estudo das intercorrências do acesso vascular temporário e definitivo

Abstract

The complications of vascular access has been the leading cause of hospitalization among patients with End Stage Renal Disease (ESRD) on hemodialysis. This study aims to assess the most used type of initial vascular access, complication rates and access survival in children and adolescents who initiated hemodialysis under the age of 18 years, using temporary vascular access, Central Venous Catheter (CVC), or permanent vascular access, Arterio Venous Fistula (AVF ), in dialysis units in Belo Horizonte, in the period January 1997 to December 2007. We studied 251 vascular access in 61 patients, 97 FAV and 154 CVC. From this total, 72% of patients came from a pediatric nephrology outpatient clinic, 51% started treatment by CVC with the vast majority of central venous uncuffed catheter and only 2 patients were dialyzed through a central venous cuffed catheter. The main cause of CVC removal was infection (35%), with mean survival of 40 days, followed by the use of AVF (29%). The AVF had primary cause of failure thrombosis (84%) with mean survival of 54 months. A primary failure of AVF was detected in 37.8% of fistulas. The uropathy (RR = 3.2, p = 0.012), time of maturation of AVF less than 90 days (RR = 4.4, p = 0.011) and CVC as initial access (RR = 3.8, p = 0.025) were predictive of loss of the AVF. In conclusion, patients with obstructive uropathy had a higher risk of loss of AVF and therefore the preparation and use of this access in this group of patients should receive special care. The puncture of the AVF with less than 90 days of creation was the cause of access failure and should therefore be avoided. Infection was the major reason for temporary removal of CVC and its use should be discontinued for patients with ESRD and should be replaced by central venous cuffed catheter or a permanent vascular access, made in a timely manner.