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

Richards, James; Hossain, Mohammed Akhter; Summers, Dominic M.; Slater, Matthew S.; Bartlett, Matthew; Kosmoliaptsis, Vasilis; Wilson, Ed; Lagaac, Regin; Sidders, Anna; Foley, Claire; Laing, Emma; Hopkins, Valerie; Fitzpatrick-Creamer, Chloe; Hudson, Cara; Thomas, Helen; Turner, Stuart; Tambyraja, Andrew L.; Somalanka, Subash; Hunter, James; Dutta, Sam; Lawman, Sarah; Salter, Tracey; Aslam, Mohammed; Bagul, Atul; Sivaprakasam, Rajesh; Smith, George E.; Moinuddin, Zia; Knight, Simon; Paul, Subhankar; Motallebzadeh, Reza; Barnett, Nicholas; Pettigrew, Gavin J.

doi:10.1136/bmjopen-2019-031210

Cited by 12 publications

(10 citation statements)

References 20 publications

(13 reference statements)

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“…Webinars demonstrating both scanning techniques and physical assessment of the AVF can be another opportunity to support these sonographers. Given the variations in criteria to assess AVF, which exist both in Australia and globally, 9,28–30 it may be difficult for a sonographer to be able to determine which is the most applicable criteria in their situation. Therefore, the development of a standard protocol seems critical with input from the wider kidney disease community.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound of dialysis fistulae: Factors influencing Australian practice

2021

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Introduction: Due to the increasing prevalence of kidney failure in Australia, more sonographers are being expected to perform ultrasound examinations of arteriovenous fistulae (AVF), even when they may receive little support to do so. Methods:We surveyed respondents through the Australasian Sonographers Association (ASA), regarding their demographics, workplace, and experience in relation to AVF ultrasound examinations.Results: Fifty sonographers participated from metropolitan and regional areas.Sonographers in metropolitan areas had approximately three times more access to support compared to those in rural/remote areas, in performing AVF ultrasound examinations. Self-reported competency levels of AVF ultrasound examinations were novice/advanced beginner 28.6%, competent 30%, proficient/expert 40%. Less than a fifth of sonographers always performed a physical assessment, while almost half never physically assessed an AVF. Conclusion:Rural and remote sonographers have the least access to ongoing resources and support. The knowledge of the supporting role that non-ultrasound methods of AVF surveillance can play in improving the quality of ultrasound assessments, varied mainly by perception of competency. Sonographer competency, education, and support in AVF assessment is vital to avoid clinical uncertainty. Australian sonographers would benefit from further education and support to improve competency, confidence and patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Ultrasound of dialysis fistulae: Factors influencing Australian practice

2021

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“…5 An upcoming, multi-centre trial from the United Kingdom may help provide further clarity to this issue in the future. 18…”

Section: Discussionmentioning

confidence: 99%

Outcomes of post-operative duplex ultrasound following arteriovenous fistula formation: A pragmatic single-centre experience

et al. 2019

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Background: Duplex ultrasound surveillance with pre-emptive treatment of an identified stenosis is increasingly being utilised to help maintain arteriovenous fistula patency. This study aims to determine whether post-operative duplex ultrasound surveillance can improve fistula patency at 12 months and improve the proportion of ‘pre-haemodialysis’ patients commencing haemodialysis via a usable fistula. Methods: All arteriovenous fistulae formed between 1st January 2015 and 31st August 2017 in a single, tertiary vascular centre were included. Primary and secondary patency at 12 months, along with the proportion of pre-haemodialysis patients commencing haemodialysis via a usable arteriovenous fistula, were compared between the fistulae undergoing duplex ultrasound surveillance and ‘standard practice’. Results: Two hundred forty-one arteriovenous fistulae were created in 216 patients. A higher proportion of brachiobasilic transposition arteriovenous fistula and patients undergoing arteriovenous fistula creation following a previously failed access were identified in the duplex ultrasound surveillance group. Primary patency at 12 months (hazard ratio = 0.43, 95% confidence interval = 0.30–0.61, p < .001) was significantly lower in the duplex ultrasound surveillance group compared with the ‘standard practice’ group. Despite this, no difference was identified in secondary patency at 12 months (hazard ratio = 1.82, 95% confidence interval = 0.87–3.80, p = .112). No difference was also identified in the proportion of pre-haemodialysis patients starting haemodialysis with a usable arteriovenous fistula (duplex ultrasound surveillance = 65.0% vs standard practice = 77.8%; odds ratio = 0.53, 95% confidence interval 0.58–1.19, p = .279). Conclusion: Post-operative duplex ultrasound surveillance following arteriovenous fistula formation is associated with higher rates of post-operative intervention; however, this does not translate into improved secondary patency or the proportion of pre-haemodialysis patients commencing HD via their fistula.

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“…Kudlicka et al found that duplex Doppler ultrasound examination of AVG early after creation can identify those at substantial risk for stenosis and access loss ( 19 ). A primary outcome of the ongoing multicenter observational surveillance of AVF using ultrasound study (SONAR) aims to examine a role of Doppler ultrasound surveillance protocol to detect potentially correctable early problems in fail-to-mature fistulas ( 20 ).…”

Section: Maturationmentioning

confidence: 99%

The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Saati¹,

Puffenberger²,

Kirksey³

et al. 2023

Cardiovasc Diagn Ther

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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.

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

Cited by 12 publications

References 20 publications

Ultrasound of dialysis fistulae: Factors influencing Australian practice

Ultrasound of dialysis fistulae: Factors influencing Australian practice

Outcomes of post-operative duplex ultrasound following arteriovenous fistula formation: A pragmatic single-centre experience

The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

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