Arterio-venous fistula in end stage renal disease child

Abstract

Chronic kidney disease is now the accepted term in the pediatric nephrology community replacing the clinical terms of chronic renal failure and chronic renal insufficiency which is defined as the presence of markers of kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney with or without a decreased glomerular filtration rate. In the very young child, congenital anomalies are the most common cause. Whereas glomerulopathies are more common in older children. There is limited information on the epidemiology of chronic kidney disease in the pediatric population. As it is often asymptomatic in its early stages specially in the African countries because of the lack of renal registries. However, there is a general impression that CKD is at least three to four times more frequent in Africa than in more industrialized countries. The options for renal replacement therapy include peritoneal dialysis, hemodialysis, and renal transplantation. The success of chronic hemodialysis depends on good vascular access: internal arteriovenous fistula, graft or central venous catheter. Complications of central venous catheters include infection, malfunction, central venous compromise, bleeding and catheter cracks. Other disadvantages include discomfort from external device so the best form of access is an arteriovenous fistula which is associated with more effective dialysis and fewer complications. The procedures is to provide long-term dialysis access that will remain patent over time with a low risk of complications. To accomplish this goal, a few general principles are applied. Arteriovenous accesses are placed as far distally in the upper extremity as possible to preserve proximal sites for future accesses. When possible, autogenous AV accesses should be considered before prosthetic arteriovenous accesses are placed. These autogenous access configurations should include, in order of preference, the use of direct AV anastomosis, venous transpositions, and translocations. Upper extremity access sites are used first, with the nondominant arm given preference over the dominant arm only when access opportunities are equal in both extremities. Lower extremity and body wall access sites are used only after all upper extremity access sites have been exhausted.