Effects of hemodialysis access surveillance on reducing risk of hemodialysis access thrombosis: A meta‐analysis of randomized studies

Abstract

Introduction Vascular access thrombosis remains the Achilles Heel for many a hemodialysis patient. We performed a systematic review and meta‐analysis to assess the impact of monitoring vascular access blood flow on prediction and prevention of vascular access thrombosis. We hypothesized that monitoring vascular access blood flow has a pivotal role in lowering the risk of thrombosis and subsequent access failure. Methodology We conducted a systematic review in PubMed and EMBASE databases to identify randomized studies that have assessed the effect of hemodialysis access surveillance on the risk of thrombosis. A random‐effects model was used for the meta‐analysis. Subgroup analysis was performed among patients with arterio‐venous fistula (AV‐fistulas) and those with arterio‐venous graft (AV‐grafts). Results Ten randomized studies were included in the meta‐analysis. The total number of patients included in the analysis was 1430. On performing the random‐effects model among the included studies, hemodialysis access surveillance was associated with better outcomes (risk ratio = 0.73, 95% confidence interval ranges from 0.55 to 0.98). The analysis of the AV‐fistula group showed an estimated overall risk ratio of 0.55 (95% confidence interval ranges from 0.33 to 0.89) favoring access surveillance. However, in the AV‐grafts group, the estimated overall risk ratio was 0.92 (95% confidence interval ranges from 0.65 to 1.29) showing no additional benefit for access surveillance. Conclusion Hemodialysis access surveillance using access blood flow monitoring can reduce the risk of access thrombosis for patients with AV‐fistulas, but this is not the case with AV‐grafts.

Hemodialysis vascular access flow measurements by the novel DMed NephroFlow® device: A comparative study with Transonic®

“…4 The latest randomized clinical trials and subsequent metaanalysis have revealed that VA flow monitoring has a positive predictive value to identify VA at risk of developing thrombosis. [5][6][7][8] Although VA duplex ultrasonography (DUS) is currently a method that is acquiring a greater relevance, it is not available in all centers and there are several disadvantages dependant on the operator's experience and accuracy. 9 Classic ultrasound dilution (UD) methods allow detection of AVF risk through a simple method with computer-calculated results.…”