Chapter 190 - HD access in pediatric patient

Question 1

Pediatric ESRD rate of different treatments

Answer 1

Transplant 25.1%
PD 18.3%
HD 55.8%

Question 2

KQODI guideline for HD access

Answer 2

1) age 0-19
2) > 20kg
3) no kidney transplant in 1 year

Question 3

Adult ESRD rate of different treatments

Answer 3

Transplant 2.6%
PD 9%
HD 88.2%

Question 4

Cause of pediatric ESRD

Answer 4

1) cystic/hereditary/congenital 33%
2) glomerulonephritis 24.6%
3) focal glomerular sclerosis 12.7%
4) renal hypoplasia/dysplasia 9.8%
5) congenital obstructive uropathies 9.2%
6) lupus 7.5%

Question 5

5 year survival in pediatric ESRD

Answer 5

89%

worse in youngest group (age 0-4)
Best if received transplant

Question 6

Mortality cause in pediatric ESRD

Answer 6

1) cardiopulmonary 21%

2) bacterial infection 11.1%

Question 7

HD in pediatric that start with CVC

Answer 7

80%

Question 8

Durability of CVC

Answer 8

0-62% at 1 year

Question 9

Reason for CVC failure

Answer 9

infection 17-40%
thrombosis 33%
accidental extrusion 5-10%
kinking

Question 10

KDOQI guideline on sequence of vein selection for CVC

Answer 10

1) right IJ
2) right EJ
3) left IJ and EJ
4) subclavian veins
5) femoral veins
6) translumbar and transhepatic to IVC

Question 11

Age and size of CVC algorithm

Answer 11

Size (Fr) = age +/- 2

Question 12

AVF in children primary and secondary patency at 2 and 4 years

Answer 12

2 year
83% primary
92% secondary

4 year
65% primary
83% secondary

Question 13

Size cutoff for veins in forearm and upper arm

Answer 13

Forearm > 2mm

Upper arm > 2.5 mm