Good outcomes for arteriovenous fistula with buttonhole cannulation for chronic hemodialysis in children and adolescents

Background Arteriovenous fistula (AVF) is the preferred access for chronic hemodialysis (HD) in children and adolescents, but central venous catheter use is still high. Methods Retrospective chart review of children and adolescents with AVF created between January 2003 and December 2015 was performed to assess primary failure (PF), maturation time, functional primary and functional cumulative patency, and potential risk factors for AVF dysfunction. Results Ninety-nine AVF were created in 79 patients (54% male; 7–24 years; 16–147 kg) by experienced surgeons. Duplex ultrasonography vein mapping was used to assist with site selection. PF occurred in 17 AVF (17%) in 14 patients. Patient age, gender, ethnicity, underlying disease, time on dialysis, and AVF site were not associated with PF or patency. Coagulation abnormality was positively associated with PF ( p = 0.03). Function was achieved in 82 AVF (83%) in 77 patients (97%). Median maturation time was 83 days (range 32–271). AVF were accessed via buttonholes. Functional primary patency was 95%, 84%, and 53% at 1, 2, and 5 years. Overall 1- and 2-year functional cumulative patency was 95%, but lower for small patients 16–30 kg (88%) and those greater than 80 kg (91%). The 5-year patency rate was 80%, but significantly lower for 16–30 kg (59%) and greater than 80 kg (55%). Risk analysis showed significantly better patency for 31–45 kg and 46–80 kg groups ( p < 0.01), non-obese BMI ( p = 0.01), and buttonhole self-cannulation ( p = 0.03). Conclusions This study provides more information about successful AVF with buttonhole cannulation in pediatric hemodialysis patients lending additional support for AVF use in pediatrics. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information