Dialysis Access in the Pediatric Population

Pediatric end-stage renal disease (ESRD), largely due to congenital and acquired causes, is a challenge for caregivers, nephrologists, and surgeons. Although roughly a quarter of pediatric patients initiating treatment for ESRD do so with transplantation and some with peritoneal dialysis (PD), over half of patients utilize hemodialysis (HD) as their first modality of renal replacement therapy. However, many of these suitable patients commence HD treatment via central venous catheters (CVCs) despite results demonstrating that arteriovenous fistulas (AVFs) are superior. CVCs are associated with higher complications, more hospitalizations, and increased mortality when compared to AVF. Given that the majority of pediatric ESRD patients will outlive at least one transplant and return to HD, providers should steer away from using catheters as the primary treatment modality and avoid the life-long implications of catheter-related complications. Dialysis access creation in the pediatric population should include careful patient selection and surgical considerations.