Risk score used during access surveillance may predict stenosis
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Use of a risk score while monitoring the patency of a hemodialysis vascular access may help predict the development of stenosis and provide an objective measure for risk stratification, researchers concluded in a recently published study.
“Improving the survival of arteriovenous dialysis accesses has remained a long-standing problem,” Lalathaksha Kumbar, MD, of the division of nephrology and hypertension at Henry Ford Hospital in Detroit, and colleagues wrote in their study published in the Journal of Vascular Access. “The development of progressive vascular access stenosis with subsequent access failure contributes to significant morbidity of patients on dialysis, as well as economic burden.”
Multiple failures make it more difficult for a vascular access to succeed, Kumbar and his colleagues wrote. “Conversion from a permanent vascular access to a catheter increases mortality by 80%, and the incidence of primary AVF failures increases with each successive fistula placement,” they wrote. “Any delay in identifying dysfunctional accesses can lead to complications like aneurysmal degeneration, thrombosis, and even catastrophic consequences like spontaneous rupture and death.”
Adult patients receiving hemodialysis at a single dialysis unit through an arteriovenous access, either a fistula or graft, were enrolled in the study and monitored from August 2021 through October 2021. Researchers compared the occurrence of access stenosis (defined as greater than 50% on ultrasonography or angiography) among patients in a low-risk group (n = 18 patients) and a high-risk group (n = 20 patients) and assessed clinical monitoring results for each group.
Researchers tested an access surveillance device called Vasc-Alert (Vasc-Alert LLC) to monitor the arteriovenous accesses in the patient group. The scoring system of the device “provides a risk stratification algorithm based on Vasc-Alert vascular access surveillance technology,” the researchers wrote.
Of the 38 patients analyzed, 16 (42%) had significant stenosis. “Clinical monitoring results were positive in 39% of the low-risk and 60% of the high-risk group,” Kumbar and colleagues wrote. “The high-risk group had significantly higher occurrence of stenosis than the low-risk group (65% vs. 17%; P = .003). Sensitivity and specificity of a high score for identifying stenosis were 81% and 68%, respectively.”
They added, “Only 11 (58%) of 19 subjects with positive clinical monitoring had significant stenosis.”
In this study, “we observed that patients receiving dialysis through arteriovenous access with high-risk VA score were more likely to have significant stenosis than patients with a low-risk VA score,” the researchers wrote. “These findings suggest that a higher VA score may be useful for predicting which patients may have clinically significant stenosis as seen in imaging studies,” Kumbar and colleagues wrote. “We also observed that positive clinical monitoring results alone were insufficient for identifying stenosis. Thus, we recommend that an automated data-driven risk stratifying scoring system may have clinical utility for preventing and/or expediently treating access stenosis in patients who receive dialysis.”
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