The Hemodialysis Access Surveillance Controversy Continues.
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ABSTRACT:
SUBMITTER: Anvari E
PROVIDER: S-EPMC7529591 | biostudies-literature | 2020 Nov
REPOSITORIES: biostudies-literature
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The Hemodialysis Access Surveillance Controversy Continues.
Anvari Evamaria E Vachharajani Tushar J TJ
Kidney international reports 20201002 11
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Project description: Not available
| S-EPMC3220037 | biostudies-literature
Project description:IntroductionArteriovenous (AV) access thrombosis remains 1 of the most troubling AV access-related complications affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk of AV access loss. AV access stenosis is found in the majority of thrombosed AV accesses. The routine use of AV access surveillance for the early detection and management of stenosis to reduce the thrombosis rate remains controversial.MethodsWe have conducted a multicenter, prospective, randomized clinical trial comparing the standard of care coupled with ultrasound dilution technique (UDT) flow measurement monthly surveillance with the standard of care alone.ResultsWe prospectively randomized 436 patients with end-stage renal disease on hemodialysis with arteriovenous fistula (AVF) or arteriovenous graft (AVG) using cluster (shift) randomization to surveillance and control groups. There were no significant differences in the baseline demographic data between the 2 groups, except for ethnicity (P = 0.017). Patients were followed on average for 15.2 months. There were significantly less per-patient thrombotic events (Poisson rate) in the surveillance group (0.12/patient) compared with the control group (0.23/patient) (P = 0.012). There was no statistically significant difference in the total number of procedures between the 2 groups, irrespective of whether thrombectomy procedures were included or excluded, and no statistically significant differences in the rate of or time to the first thrombotic event or the number of catheters placed due to thrombosis.ConclusionThe use of UDT flow measurement monthly AV access surveillance in this multicenter randomized controlled trial reduced the per-patient thrombotic events without significantly increasing the total number of angiographic procedures. Even though there is a trend, surveillance did not reduce the first thrombotic event rate.
| S-EPMC7609971 | biostudies-literature
Project description:The rise in prevalence of end stage renal disease (ESRD) and the impact on health care resulted in increasing focus on delivery of vascular access. Hemodialysis vascular access is the most common renal replacement therapy method. The vascular access types include arteriovenous fistula, arteriovenous graft, and tunneled central venous catheters. Vascular access function remains an important outcome measure with significant impact on morbidity and health care cost. The survival and quality of life of patients on hemodialysis is dependent on the adequacy of dialysis through proper vascular access. Early detection of failure to mature vascular access, stenosis, thrombosis, and aneurysm or pseudoaneurysm formation remains crucial. Ultrasound can help identify complications, even though ultrasound evaluation of the arteriovenous access is less well defined. Some published vascular access guidelines support ultrasound for detecting stenosis. The evolution of ultrasound has improved throughout the years, both multi parametric top-line systems and hand-held systems. Ultrasound evaluation is inexpensive, rapid, noninvasive, and repeatable, it is a powerful tool used for early diagnosis. The ultrasound image quality still depends on the skill of the operator. Careful attention to technical details is needed and avoidance of several diagnostic pitfalls is necessary. This review is focused on the role of ultrasound for hemodialysis access surveillance, evaluation of maturation, detection of access complications, and aid with cannulation.
| S-EPMC9971298 | biostudies-literature
Project description:Background: Arteriovenous grafts (AVGs) are an alternative for hemodialysis (HD) access in patients with inadequate vasculature or advanced age. The effect of routine surveillance for AVG maintenance remains unclear. This study assesses the clinical and economic outcomes of routine surveillance at a collaborative clinic in patients with previous access complications. Methods: We recruited HD patients from the initiation of the clinic in 2020, and divided them into two groups: those receiving routine surveillance and those without. Primary outcomes included AVG interventions (e.g., arteriovenous access [AVA] reconstruction, graft-anastomosis stenting, percutaneous transluminal angioplasty [PTA]). Other outcomes included AVG secondary patency and costs associated with the interventions. Results: Twenty-two patients with routine surveillance and 65 without were recruited. There was no significant difference in AVA reconstruction rate between the surveillance and non-surveillance groups (0.46 vs. 0.5 per 100 patient-months, p = 0.99), however, rates of graft-anastomosis stenting (0.66 vs. 0.2 per 100 patient-months, p = 0.02) and PTA (30.19 vs. 14.17 per 100 patient-months, p < 0.01) were significantly higher in the surveillance group. No significant difference was observed in secondary patency (hazard ratio: 0.83, p = 0.79). The total costs of AVG interventions were more than double in the surveillance group (110672 New Taiwan Dollar [NTD] vs. 51874 NTD, p < 0.01). Conclusions: Routine clinic surveillance in HD patients with AVGs and previous access complications resulted in significantly higher rates of graft-anastomosis stenting, PTA, and associated costs, without significant differences in AVA reconstruction rates or secondary patency. These results highlight the need for further assessment of the cost-effectiveness of routine AVG monitoring.
| S-EPMC11866542 | biostudies-literature
Project description:Arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing hemodialysis and the majority of AVFs fail because of venous intimal hyperplasia (VNH). Results from our lab have shown that adipose tissue-derived mesenchymal stem cell (MSC) transplantation to the adventitia of the outflow vein of AVF attenuates VNH in an immunodeficient mice. In the present study efficacy of Human AMSCs transplantation in treating AVF failure was tested in FoxN1 Nude mice with surgically created AVF. To explore the molecular mechanisms involved in MSCs transplantation improving AVF durability, we performed RNA-seq transcriptome analysis of the outflow veins of AVFs excised from mice 3 days after adventitial transplantation of MSCs.
2025-07-07 | GSE223511 | GEO
Project description:This SuperSeries is composed of the SubSeries listed below.
2025-07-07 | GSE179959 | GEO
Project description:Arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing hemodialysis and the majority of AVFs fail because of venous intimal hyperplasia (VNH). Results from our lab have shown that adipose tissue-derived mesenchymal stem cell (MSC) transplantation to the adventitia of the outflow vein of AVF attenuates VNH in an immunodeficient mice. in the present study efficacy of AMSCs transplantation in treating AVF failure was tested in a chronic kidney disease (CKD) followed by an AVF created in C57BL/6 mice and porcine models as described in methods. Moreover, a phase 1 trial was performed in small group of endstage renal disease (ESRD) patients who are in hemodialysis. To explore the molecular mechanisms involved in MSCs transplantation improving AVF durability, we performed RNA-seq transcriptome analysis of the outflow veins of AVFs excised from mice and Pigs the after adventitial transplantation of MSCs from the donor inbred C57BL/6 mice or pigs respectively. RNA-seq on AMSCs isolated from donor mice, pigs and from patients of Phase 1 study was performed and CD markers of MSCs were compared to assess the homogenicity of isolated AMSCs with in the species.
2025-07-07 | GSE179957 | GEO
Project description:Most arteriovenous grafts fail due to irreversible thrombosis, and most clotted grafts have an underlying stenotic lesion. These observations raise the plausible hypothesis that early detection of graft stenosis with preemptive angioplasty will reduce the likelihood of graft thrombosis. A number of noninvasive methods can be used to detect hemodynamically significant graft stenosis with a high positive predictive value. These tests include clinical monitoring, as well as surveillance by static dialysis venous pressures, flow monitoring, or duplex ultrasound. However, these surveillance tests have a much lower positive predictive value for graft thrombosis in the absence of preemptive angioplasty. In other words, none of the currently available surveillance tests can reliably distinguish between stenosed grafts destined to clot, and those that will remain patent without intervention. As a consequence, any program of graft surveillance necessarily results in a substantial proportion of unnecessary angioplasties. Moreover, a substantial proportion of grafts thrombose despite a normal antecedent surveillance test. Numerous observational studies have found an impressive reduction of graft thrombosis after implementation of a stenosis surveillance program. In contrast, 5 of 6 randomized clinical trials failed to show a reduction of graft thrombosis in patients undergoing graft surveillance, as compared with those receiving only clinical monitoring. The lack of benefit of surveillance is largely attributable to the rapid recurrence of stenosis after angioplasty. Thus, routine surveillance for graft stenosis, with preemptive angioplasty, cannot be recommended for reduction of graft thrombosis. Future research should be directed at pharmacologic interventions to prevent graft stenosis.
| S-EPMC4017945 | biostudies-literature
Project description:Rationale & objectiveAccess patency outcomes for arteriovenous fistulas (AVFs) as compared with arteriovenous grafts (AVGs) in patients receiving hemodialysis (HD) who have achieved a functioning permanent access are not fully explored.Study designObservational cohort study.Setting & populationFee-for-service Medicare beneficiaries aged ≥18 years with kidney failure who were newly using a permanent access for maintenance HD from the United States Renal Data System (2010-2015). Patients using an oral anticoagulant were excluded.ExposureAVG or AVF.OutcomesLoss of primary unassisted, primary assisted, and secondary patency.Analytical approachOutcomes were characterized using cumulative incidence curves, and HRs adjusted for sociodemographic and clinical factors were estimated for the comparison of AVF versus AVG.ResultsThe cohort included 60,329 and 17,763 patients newly using an AVF and AVG, respectively, for HD. Over 3 years of follow-up, AVG users, compared to AVF users, had a higher cumulative incidence of loss of primary unassisted patency (87% vs 69%; HR, 1.56; 95% CI, 1.52-1.60), loss of primary assisted patency (69% vs 25%; HR, 3.79; 95% CI, 3.67-3.92), and loss of secondary patency (22% vs 10%; HR, 2.03; 95% CI, 1.92-2.16). Stratified analyses revealed differences by subgroups; in particular, incidence of patency loss was higher among patients who underwent prior interventions to maintain prefunctional access patency and Black patients.LimitationsThis analysis focused on outcomes occurring after first successful use of a permanent access and thus does not inform about risk of patency loss during access maturation.ConclusionsAmong patients with kidney failure who successfully used a permanent access for HD, patency loss was consistently substantially higher in those using AVGs compared with AVFs. New interventions, such as prophylactic drugs, are needed to improve access longevity and reduce the need for invasive interventions, particularly among patients unable to receive a fistula.
| S-EPMC9829958 | biostudies-literature
Project description:Arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing hemodialysis and the majority of AVFs fail because of venous intimal hyperplasia (VNH). Results from our lab have shown that adipose tissue-derived mesenchymal stem cell (MSC) transplantation to the adventitia of the outflow vein of AVF attenuates VNH in an immunodeficient mice. in the present study efficacy of AMSCs transplantation in treating AVF failure was tested in a chronic kidney disease (CKD) followed by an AVF created in C57BL/6 mice and porcine models as described in methods. Moreover, a phase 1 trial was performed in small group of endstage renal disease (ESRD) patients who are in hemodialysis. To explore the molecular mechanisms involved in MSCs transplantation improving AVF durability, we performed RNA-seq transcriptome analysis of the outflow veins of AVFs excised from mice and Pigs the after adventitial transplantation of MSCs from the donor inbred C57BL/6 mice or pigs respectively. RNA-seq on AMSCs isolated from donor mice, pigs and from patients of Phase 1 study was performed and CD markers of MSCs were compared to assess the homogenicity of isolated AMSCs with in the species.
2025-07-07 | GSE179955 | GEO