Abstract:

Objective To investigate the influence of the change of renal transplantation allocation policy in China on the selection of vascular access in children with maintenance hemodialysis. Methods The clinical data of children who underwent hemodialysis and established long-term vascular access from January 2013 to December 2022 were collected, including age, weight, body mass index, primary disease, type of vascular access at the first hemodialysis, etc. The types and numbers of vascular access in children before and after the introduction of the new policy of "child priority" renal transplantation in China in 2018 were statistically analyzed, and the change trend and influencing factors were summarized. Results A total of 118 children (66 boys and 52 girls) were included. The mean age was (11.4±2.9) years, and the median body weight was 31.1 (23.9-43.3) kg. The main causes of end stage renal disease (ESRD) in children were congenital anomalies of the kidneys and urinary tracts (CAKUT) and primary renal diseases. At the first dialysis, 96.6% of the children had temporary central venous catheter (CVC), and the remaining 3.4% had arteriovenous fistula (AVF). After the implementation of the new policy of "child priority" renal transplantation, the median waiting time for kidney transplantation in children with maintenance hemodialysis was shortened from 19.5 months to 8 months. The proportion of children choosing AVF as long-term vascular access decreased from 86.7% to 43.1%; conversely, the proportion of children choosing tunnel-cuffed catheter (TCC) as long-term vascular access increased from 13.3% to 56.9%. Conclusions After the implementation of the "child priority" kidney transplant allocation policy, TCC replaced AVF as the preferred vascular access for children with ESRD on maintenance hemodialysis.

Key words: end-stage renal disease, maintenance hemodialysis, vascular access, renal transplantation policy