A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation

Han, Ahram; Min, Seung-Kee; Kim, Misook; Joo, Kwon Wook; Kim, Jung-Sun; Ha, Jong‐Won; Lee, Joongyub; Min, Seok-Ki

doi:10.2215/cjn.00620116

Cited by 27 publications

(28 citation statements)

References 23 publications

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“…In our trial, hypertension was the main cause of CKD followed by diabetes, and showed predominance in males, which is in agreement with several other studies. 2,11,[22][23][24][25][26][27] Compared to previous studies, we found a slightly lower failure rate. 22,[28][29][30] We found no statistically significant association between fistula failures and risk factors such as advanced age, female gender, and diabetes, as reported in some studies.…”

Section: Discussioncontrasting

confidence: 74%

The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

2020

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Introduction: The increasing prevalence of chronic kidney disease has increased the demand for arteriovenous fistula (AVF) care. The objective of this study was to assess the relationship between some risk factors for AVF failure (advanced age, female sex, diabetes, obesity, central venous catheter, previous fistula, and hospitalization) and having a Doppler ultrasound performed preoperatively. Methods: A prospective study was performed with 228 dialysis patients from Imperatriz, Maranhão. Half of the sample was randomly selected to receive preoperative Doppler ultrasound and the other half did not, from the period of October 2016 to September 2018. Results: There were 53 total failures corresponding to 23.2% of our sample, which is almost double that of the patients in the clinical group. Considering the failures and risk factors associated with the overall sample, there was a statistically significant association between a central venous catheter on the same side of the AVF with P = 0.04 (Odds Ratio 1.24) and obesity with P = 0.05 (Odds Ratio 1.36), which was not repeated in the Doppler ultrasound group individually. There was no statistically significant difference between the Doppler group and clinical group with respect to the amount of days of previous AVF hospitalization and failure. Conclusions: We concluded that the reduction of failures with an introduction of the Doppler was statistically significant in the overall sample, but establishing a relationship between specific risk factors and failure was only possible with two of the risk factors in the study - obesity and central venous catheter on the same side of the AVF.

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Section: Discussioncontrasting

confidence: 74%

The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

2020

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“…Some studies clinically defined non-maturation based on insufficient vessel development 1 month after creation, difficulties in cannulation, or impossibility to achieve a flow rate >300 mL/min or as the presence of a fistula that had been created for at least 8 weeks but was not mature enough to allow successful cannulation or be used during HD. 21 , 22 We agree that maturation according to the clinical criteria (adequacy for dialysis) is the gold standard 23 and involves a functional AVF that can supply enough blood flow to achieve a minimum target dose of dialysis.…”

Section: Discussionmentioning

confidence: 92%

Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

Zhang

Wan

et al. 2019

J Vasc Access

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Target: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm. Methods: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas. Results: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t = −3.136, p = 0.003) and blood flow volume (33.98 times vs 54.11 times, t = −2.383, p = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height. Conclusion: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.

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“…There was no control cohort (patients who did not undergo routine surveillance), but the assisted patency reported for the entire study population would appear to be better than generally reported following fistula creation. One randomised study has evaluated routine early US surveillance (2, 4 and 8 weeks after fistula creation, 150 patients) and reported a 13.6% fistula failure/non-maturation rate in the surveillance group, compared with 25.4% in the control group in whom US was performed on the basis of a perceived clinical indication 17. This difference did not reach statistical significance, but notably, the study was powered for a 20% difference in maturation.…”

Section: Introductionmentioning

confidence: 99%

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study

et al. 2019

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IntroductionArteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.The Surveillance Of arterioveNous fistulAe using ultRasound study will examine whether a protocolised programme of Doppler ultrasound (US) surveillance can identify, early after creation, potentially correctable problems in those AVFs that subsequently fail to mature.Methods and analysisThis is a multicentre observational study that will assess newly created AVFs by Doppler US performed at 2, 4, 6 and 10 weeks after creation. The primary outcome measure will be primary fistula patency at week 10. Secondary outcome measures include: successful use of the fistula; clinical suitability for dialysis; creation of new fistula or radiological salvage; fistula thrombosis; secondary fistula patency rate and patient acceptability.Ethics and disseminationThe study has been approved by the Cambridgeshire and Hertfordshire Research Ethics Committee and by the Health Research Authority (REC 18/EE/0234). The results generated from this work will be published as open access, within 3 years of trial commencement. We will also present our findings at key national/international renal meetings, as well as support volunteers at renal patient groups to disseminate the trial outcome.Trial registration numberISRCTN36033877

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A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation

Cited by 27 publications

References 23 publications

The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors

Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study

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