Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula
We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention. Consenting adults underwent blinded fortnightly ultrasound scanning...
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Published in | Kidney international reports Vol. 9; no. 4; pp. 1005 - 1019 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.04.2024
Elsevier |
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Abstract | We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.
Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.
Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.
Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation.
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AbstractList | We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.
Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.
Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9-77.3]; elbow, 66.7% [48.9-84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan's findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.
Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation. IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9-77.3]; elbow, 66.7% [48.9-84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan's findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation. We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention. Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling. Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data. Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation. [Display omitted] |
Author | Norton, Andrew Sivaprakasam, Rajesh Gavrila, Madita Lagaac, Regin Hare, Naomi Gallagher, Karen Parsons, Joseph Gardiner, Phil Kerr, John Thialli, Manoj Lai, Jessica Laing, Emma Dutta, Sam Clementoni, Laura Pugh, Elisabeth Ghazanfar, Abbas Rabuya, May Patel, Jashree Cai, Paris Jerram, Anna Smith, Mel Rowe, Tracey Hossain, Mohammad Ayaz Bodneck, Caroline Toska, Valentina Smith, George Daniel, Simon Crawford, Kate Lawman, Sarah Burney, Kashif Trivedi, Kate Chapman, Lianne Hardy, Elizabeth Benny, Laijee Weerasinghe, Thanuja Hyndman, Samantha Thomas, Helen Knight, Simon Fitzpatrick-Creamer, Chloe Bartlett, Matthew Summers, Dominic Truslove, Maria Allen, Elisa Potter, Rachael Cheal, Darren Evans, Gail Shah-Goodwin, Lorraine Khosla, Nalin Augustin, Martia Fleet, Ana Sidders, Anna Morgan, Maria Basnayake, Duminda Scott, Laura Widdup, Joanne Carmichael, Sarah-Jane Walker, Alycon Hossain, Mohammed Banda, Joyce Brand, Sarah Hoye, Neil Crane, Jeremy Slater, Matthew Lena, Midel Badhan, Rani Bajwa, Adnan Pettigrew, Gavin J. Eadie, Tom Bagul, Atul Read, Kerry Somalanka |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38765580$$D View this record in MEDLINE/PubMed |
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ContentType | Journal Article |
Contributor | Norton, Andrew Gavrila, Madita Sivaprakasam, Rajesh Lagaac, Regin Hare, Naomi Gallagher, Karen Gardiner, Phil Kerr, John Thialli, Manoj Lai, Jessica Laing, Emma Dutta, Sam Clementoni, Laura Pugh, Elisabeth Ghazanfar, Abbas Rabuya, May Patel, Jashree Pettigrew, Gavin J Jerram, Anna Smith, Mel Hossain, Mohammad Ayaz Bodneck, Caroline Toska, Valentina Daniel, Simon Crawford, Kate Burney, Kashif Lawman, Sarah Trivedi, Kate Hardy, Elizabeth Benny, Laijee Hyndman, Samantha Thomas, Helen Knight, Simon Fitzpatrick-Creamer, Chloe Bartlett, Matthew Summers, Dominic Truslove, Maria Potter, Rachael Cheal, Darren Evans, Gail Shah-Goodwin, Lorraine Khosla, Nalin Augustin, Martia Fleet, Ana Sidders, Anna Morgan, Maria Basnayake, Duminda Scott, Laura Widdup, Joanne Carmichael, Sarah-Jane Hossain, Mohammed Banda, Joyce Brand, Sarah Slater, Matthew Lena, Midel Badhan, Rani Bajwa, Adnan Eadie, Tom Read, Kerry Somalanka, Subash Bolsworth, Amy Tiivas, Carl Ayorinde, Tobi van Selm, Judy Kathirvel, Manikandan Motallebzadeh, Reza Parsons, Karen Ansu, Kwame Beech, Andrew Suther |
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Copyright | 2024 2024 Published by Elsevier, Inc., on behalf of the International Society of Nephrology. 2024 Published by Elsevier, Inc., on behalf of the International Society of Nephrology. 2024 |
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Keywords | hemodialysis Doppler ultrasonography surveillance arteriovenous fistula vascular access surgery |
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License | This is an open access article under the CC BY-NC-ND license. 2024 Published by Elsevier, Inc., on behalf of the International Society of Nephrology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
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Snippet | We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized... IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify... |
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SubjectTerms | arteriovenous fistula Clinical Research Doppler ultrasonography hemodialysis surveillance vascular access surgery |
Title | Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula |
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