Dialysis – Transplantation
Kidney International (2005) 68, 2352–2361; doi:10.1111/j.1523-1755.2005.00697.x
Monthly access flow monitoring with increased prophylactic angioplasty did not improve fistula patency
HASSAN SHAHIN, GEETA REDDY, MELHEM SHARAFUDDIN, DANIEL KATZ, BRADLEY S FRANZWA and BRADLEY S DIXON
Department of Medicine, Veterans Administration Medical Center and University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa; Department of Radiology, Veterans Administration Medical Center and University of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City, Iowa; and Department of Surgery, Veterans Administration Medical Center and University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
Correspondence: Bradley S. Dixon, M.D, Department of Medicine, Roy J. and Lucille A. Carver College of Medicine, E300D GH, 200 Hawkins Drive, Iowa City, IA 52242–1081 E-mail: Bradley-dixon@uiowa.edu
Received 10 January 2005; Revised 21 April 2005; Accepted 20 June 2005.
Abstract
Monthly access flow monitoring with increased prophylactic angioplasty did not improve fistula patency.
Background
Regular access monitoring is recommended to detect and treat access stenosis in order to prevent access thrombosis and failure.
Methods
In 1999, we instituted monthly access blood flow monitoring using the ultrasound dilution technique (UDT). In a sequential observational trial, 222 patients were studied for the impact of UDT monitoring on patency of their first arteriovenous autogenous fistula. Group 1, the historic group (before 1999), had 146 arteriovenous fistulas (50.7% upper arm), followed for 259 access-years. Group 2, the UDT-monitored group, had 76 arteriovenous fistulas (60.5% upper arm), followed for 123 access-years. Decision to refer for angiography was based on clinical criteria for group 1, and clinical criteria plus results of UDT flow monitoring in group 2.
Results
Cumulative patency was longer (P < 0.01) and the thrombosis rate was lower (P < 0.05) in group 2. However, the improvement occurred prior to initiation of UDT flow monitoring. Comparing outcomes in group 2 patients whose fistula survived to start flow monitoring with group 1 patients whose fistula survived at least 160 days (the median time to starting UDT monitoring in group 2), there was a sevenfold increase in angioplasty procedures (0.67 vs. 0.09 per access-year) but no improvement in the thrombosis rate or cumulative fistula patency.
Conclusion
UDT monitoring increased the rate of angioplasty procedures and thereby shortened primary unassisted patency, but did not decrease the thrombosis rate or improve cumulative fistula patency.
Keywords:
hemodialysis access patency, arteriovenous access blood flow, autogenous fistula, ultrasound dilution technique, thrombosis, angioplasty
MORE ARTICLES LIKE THIS
These links to content published by NPG are automatically generated
NEWS AND VIEWS
Dialysis Vascular access: not enough light at the end of the tunnel?
Nature Reviews Nephrology News and Views (01 Oct 2009)
RESEARCH
Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions
Kidney International Original Article
Kidney International Original Article
Kidney International Original Article
