ORIGINAL ARTICLE A comparison of arteriovenous fistulas and central venous lines for long-term chronic haemodialysis Alison Ma & Rukshana Shroff & Daljit Hothi & Marina Munoz Lopez & Faidra Veligratli & Francis Calder & Lesley Rees Received: 17 May 2012 / Revised: 13 August 2012 / Accepted: 14 August 2012 / Published online: 6 October 2012 # IPNA 2012 Abstract Background Despite the Fistula First initiative there is still reluctance to use arteriovenous fistulas (AVF) for chronic haemodialysis (HD) in children. Our aim was to compare outcomes of AVFs and central venous lines (CVL) in chil- dren on chronic HD in a centre where AVF is the primary choice for vascular access. Patients and methods This was a retrospective case notes analysis of access complications, dialysis adequacy and laboratory outcomes in children who underwent dialysis for at least a year by AVF (n 0 20, median age 14.2 years, range (2.9–16.5) and CVL (n 0 5, median age 2.4 years, range 2.0–12.2) between January 2007 and December 2010. Results Primary access failure rate (patient-months) was 1 per 78.8 for AVF (n 0 5) and 1 per 15.5 for CVLs (n 0 7, p 0 0.3). Failure thereafter was 1 per 131.3 and 1 per 18.5 for AVF and CVLs respectively (n 0 3 and 6 respectively; p 0 0.2). The annualised hospitalisation rate for access malfunction was 0.44% and 3.1% for AVFs and CVLs respectively (p 0 0.004). Patients with AVFs had a lower infection rate of 0.25 per 100 patient-months compared with CVL at 3.2 per 100 (p 0 0.002). There was no difference in dialysis adequacy or laboratory values between AVF and CVL groups. Access survival rates (including both primary and secondary access failure) were significantly higher for AVF compared with CVL (p 0 0.0002, hazard ratio 0 0.15, 95% confidence interval 0.04–0.37). Conclusions Patients with AVF spend less time in hospi- tal than those dialysed by CVLs and have a much lower access infection rate. These findings emphasise the need to use AVF as first-line access for paediatric patients on chronic HD. Keywords Haemodialysis . Arteriovenous fistula . Central venous line Introduction Arteriovenous fistula (AVF) is the recommended form of vascular access for chronic haemodialysis (HD) in adults [1]. A small number of studies with few patients have suggested that the same benefits of AVFs recognised in adults are also true in children, with fewer access-related infections and hospitalisations [2–5]. However, despite the national Fistula First initiative in North America [6], central venous lines (CVLs) remain the commonest mode of access in most centres [7, 8]. Possible causes include perception of early or imminent transplant, and technical and practical difficulties associated with young age and small size [9]. Our unit has promoted the use of AVF since 1999. Our aim, therefore, was to compare the rates of access complications with AVF and CVL, and to see if access type affects dialysis adequacy and laboratory parameters in children receiving chronic HD. Patients and methods This was a retrospective case notes review at the HD unit of Great Ormond Street Hospital for Children, United King- dom. Inclusion criteria were age <18 years and a minimum A. Ma (*) : R. Shroff : D. Hothi : M. M. Lopez : F. Veligratli : F. Calder : L. Rees Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK e-mail: maalison2000@gmail.com Pediatr Nephrol (2013) 28:321–326 DOI 10.1007/s00467-012-2318-2