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Clinical Course Associated with Vascular Access Type in a National Cohort of Adolescents Who Receive Hemodialysis: Findings from the Clinical Performance Measures and US Renal Data System Projects

Jeffrey J. Fadrowski^*, Wenke Hwang, Diane L. Frankenfield, Barbara A. Fivush^*, Alicia M. Neu^*, and Susan L. Furth^*,

^* Department of Pediatrics, Johns Hopkins University School of Medicine, Centers for Medicare & Medicaid Services, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; and Department of Public Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence to: Dr. Jeffrey J. Fadrowski, Park 335, 600 N. Wolfe Street, Baltimore, MD 21287. Phone: 410-955-2467; Fax: 410-614-3680; E-mail: jfadrow1{at}jhmi.edu

Limited research has described clinical outcomes that are associated with the type of vascular access in pediatric patients who receive maintenance hemodialysis. This retrospective cohort study examined prevalent pediatric patients who were aged 12 to <18 yr and identified in the 2000 ESRD Clinical Performance Measures Project as receiving in-center hemodialysis. Vascular access type as of December 31, 1999, was identified. These patients were linked with 1 yr of data (January 1, 2000, through December 31, 2000) from US Renal Data System standard analytic files that allow for the comparison of rates of hospitalizations and access complications by access type. Of the 418 patients who met inclusion criteria, the mean age was 15.6 yr, 53% were male, 49% were white, the mean time on dialysis was 22 mo, and 42% had a structural/urologic cause of ESRD; 42% of patients had an arteriovenous graft or fistula, and 58% had a vascular catheter. Patients with a vascular catheter as compared with those with a graft or fistula had the following adjusted relative risks (95% confidence interval): 1.84 (1.38 to 2.44) for hospitalization for any cause, 4.74 (2.02 to 11.14) for hospitalization as a result of infection, and 2.72 (2.00 to 3.69) for a complication of vascular access. Vascular catheters are the predominant access type in adolescent patients who receive maintenance hemodialysis and are associated with significantly more hospitalizations and complications.