A Meta-analysis of Randomized Clinical Trials Assessing Hemodialysis Access Thrombosis Based on Access Flow Monitoring

Where Do We Stand?

Timothy Muchayi, Loay Salman, Leonardo Tamariz, Arif Asif, Abid Rizvi, Oliver Lenz, Roberto I Vazquez-Padron, Marwan Tabbara, Gabriel Contreras

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends the routine use of hemodialysis arteriovenous (AV) access surveillance to detect hemodynamically significant stenoses and appropriately correct them to reduce the incidence of thrombosis and to improve accesses patency rates. Access blood flow monitoring is considered as one of the preferred surveillance method for both AV fistulas (AVF) and AV grafts (AVG); however, published studies have reported conflicting results of its utility that led healthcare professionals to doubt the benefits of this surveillance method. We performed a meta-analysis of the published randomized controlled trials (RCTs) of AV access surveillance using access blood flow monitoring. Our hypothesis was that access blood flow monitoring lowers the risk of AV access thrombosis and that the outcome differs between AVF and AVG. The estimated overall pooled risk ratio (RR) of thrombosis was 0.87 (95% confidence interval [CI], 0.67-1.13) favoring access blood flow monitoring. The pooled RR of thrombosis were 0.64 (95% CI, 0.41-1.01) and 1.06 (95% CI, 0.77-1.46) in the subgroups of only AVF and only AVG, respectively. Our results added to the uncertainty of access blood flow monitoring as a surveillance method of hemodialysis accesses.

Original languageEnglish (US)
Pages (from-to)E23-E29
JournalSeminars in Dialysis
Volume28
Issue number2
DOIs
StatePublished - Mar 1 2015

Fingerprint

Renal Dialysis
Meta-Analysis
Thrombosis
Randomized Controlled Trials
Confidence Intervals
Transplants
Fistula
Odds Ratio
Arteriovenous Fistula
Kidney Diseases
Uncertainty
Pathologic Constriction
Delivery of Health Care
Kidney
Incidence

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{3db7c64441d44dce8cc3eb0fe8a2dfc0,
title = "A Meta-analysis of Randomized Clinical Trials Assessing Hemodialysis Access Thrombosis Based on Access Flow Monitoring: Where Do We Stand?",
abstract = "The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends the routine use of hemodialysis arteriovenous (AV) access surveillance to detect hemodynamically significant stenoses and appropriately correct them to reduce the incidence of thrombosis and to improve accesses patency rates. Access blood flow monitoring is considered as one of the preferred surveillance method for both AV fistulas (AVF) and AV grafts (AVG); however, published studies have reported conflicting results of its utility that led healthcare professionals to doubt the benefits of this surveillance method. We performed a meta-analysis of the published randomized controlled trials (RCTs) of AV access surveillance using access blood flow monitoring. Our hypothesis was that access blood flow monitoring lowers the risk of AV access thrombosis and that the outcome differs between AVF and AVG. The estimated overall pooled risk ratio (RR) of thrombosis was 0.87 (95{\%} confidence interval [CI], 0.67-1.13) favoring access blood flow monitoring. The pooled RR of thrombosis were 0.64 (95{\%} CI, 0.41-1.01) and 1.06 (95{\%} CI, 0.77-1.46) in the subgroups of only AVF and only AVG, respectively. Our results added to the uncertainty of access blood flow monitoring as a surveillance method of hemodialysis accesses.",
author = "Timothy Muchayi and Loay Salman and Leonardo Tamariz and Arif Asif and Abid Rizvi and Oliver Lenz and Vazquez-Padron, {Roberto I} and Marwan Tabbara and Gabriel Contreras",
year = "2015",
month = "3",
day = "1",
doi = "10.1111/sdi.12342",
language = "English (US)",
volume = "28",
pages = "E23--E29",
journal = "Seminars in Dialysis",
issn = "0894-0959",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - A Meta-analysis of Randomized Clinical Trials Assessing Hemodialysis Access Thrombosis Based on Access Flow Monitoring

T2 - Where Do We Stand?

AU - Muchayi, Timothy

AU - Salman, Loay

AU - Tamariz, Leonardo

AU - Asif, Arif

AU - Rizvi, Abid

AU - Lenz, Oliver

AU - Vazquez-Padron, Roberto I

AU - Tabbara, Marwan

AU - Contreras, Gabriel

PY - 2015/3/1

Y1 - 2015/3/1

N2 - The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends the routine use of hemodialysis arteriovenous (AV) access surveillance to detect hemodynamically significant stenoses and appropriately correct them to reduce the incidence of thrombosis and to improve accesses patency rates. Access blood flow monitoring is considered as one of the preferred surveillance method for both AV fistulas (AVF) and AV grafts (AVG); however, published studies have reported conflicting results of its utility that led healthcare professionals to doubt the benefits of this surveillance method. We performed a meta-analysis of the published randomized controlled trials (RCTs) of AV access surveillance using access blood flow monitoring. Our hypothesis was that access blood flow monitoring lowers the risk of AV access thrombosis and that the outcome differs between AVF and AVG. The estimated overall pooled risk ratio (RR) of thrombosis was 0.87 (95% confidence interval [CI], 0.67-1.13) favoring access blood flow monitoring. The pooled RR of thrombosis were 0.64 (95% CI, 0.41-1.01) and 1.06 (95% CI, 0.77-1.46) in the subgroups of only AVF and only AVG, respectively. Our results added to the uncertainty of access blood flow monitoring as a surveillance method of hemodialysis accesses.

AB - The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends the routine use of hemodialysis arteriovenous (AV) access surveillance to detect hemodynamically significant stenoses and appropriately correct them to reduce the incidence of thrombosis and to improve accesses patency rates. Access blood flow monitoring is considered as one of the preferred surveillance method for both AV fistulas (AVF) and AV grafts (AVG); however, published studies have reported conflicting results of its utility that led healthcare professionals to doubt the benefits of this surveillance method. We performed a meta-analysis of the published randomized controlled trials (RCTs) of AV access surveillance using access blood flow monitoring. Our hypothesis was that access blood flow monitoring lowers the risk of AV access thrombosis and that the outcome differs between AVF and AVG. The estimated overall pooled risk ratio (RR) of thrombosis was 0.87 (95% confidence interval [CI], 0.67-1.13) favoring access blood flow monitoring. The pooled RR of thrombosis were 0.64 (95% CI, 0.41-1.01) and 1.06 (95% CI, 0.77-1.46) in the subgroups of only AVF and only AVG, respectively. Our results added to the uncertainty of access blood flow monitoring as a surveillance method of hemodialysis accesses.

UR - http://www.scopus.com/inward/record.url?scp=84924599340&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924599340&partnerID=8YFLogxK

U2 - 10.1111/sdi.12342

DO - 10.1111/sdi.12342

M3 - Article

VL - 28

SP - E23-E29

JO - Seminars in Dialysis

JF - Seminars in Dialysis

SN - 0894-0959

IS - 2

ER -