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. 2025 Jan;40(1):189-201.
doi: 10.1007/s00467-024-06488-1. Epub 2024 Sep 3.

Establishing an autogenous vascular access program in a Guatemalan comprehensive pediatric nephrology center

William C Jennings  1 , Ana Leslie Galvez  2 , Nasir Mushtaq  3 , Raúl Ernesto Sosa Tejada  4 , Alexandros Mallios  5 , John F Lucas 3rd  6 , Mark Randel  7 , Randall Lou-Meda  2
Affiliations

Establishing an autogenous vascular access program in a Guatemalan comprehensive pediatric nephrology center

William C Jennings et al. Pediatr Nephrol. 2025 Jan.

Abstract

Background: The Guatemalan Foundation for Children with Kidney Diseases collaborated with Bridge of Life, a not-for-profit charitable organization, to establish a vascular access program. We reviewed our experience with graded surgical responsibility and structured didactic training, creating arteriovenous fistulas (AVF) for Guatemalan children.

Methods: Pediatric vascular access missions were completed from 2015 to 2023 and analyzed retrospectively. Follow-up was completed by the Guatemalan pediatric surgeons, nephrologists, and nursing staff. AVF patency and patient survival were evaluated by Kaplan-Meier life-table analysis with univariate and multivariable association between patient demographic variables by Cox proportional hazards models.

Results: Among a total of 153 vascular access operations, there were 139 new patient procedures, forming the study group for this review. The mean age was 13.6 years, 42.6% were female, and the mean BMI was 17.3. Radial or ulnar artery-based direct AVFs were established in 100 patients (71.9%) and ten of the 25 transposition procedures. Brachial artery inflow was required in 29 direct AVFs (20.9%). Two patients underwent femoral vein transpositions. Access-related distal ischemia was not encountered. Seven of the AVF patients later required access banding for arm edema; all had previous dialysis catheters (mean = 9, range 4-12). Primary and cumulative patency rates were 84% and 86% at 12 months and 64% and 81% at 24 months, respectively. The median follow-up was 12 months. Overall patient survival was 84% and 67% at 12 and 24 months, respectively. There were no deaths related to AVF access.

Conclusions: Safe and functional AVFs were established in a teaching environment within a Guatemalan comprehensive pediatric nephrology center.

Keywords: AVF; Adolescents; Arteriovenous fistula; Autogenous; Children; Chronic kidney disease; Chronic renal failure; Guatemala; Hemodialysis; Kidney failure; Medical mission; Pediatric; Vascular access.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The FUNDANIER ad hoc research ethics committee granted prior approval for this retrospective chart review study. Informed consent was not required. The study was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki. Conflict of interest: The authors declare no competing interests.

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