Abstract: FR-PO955

Meta-Analysis and Commentary: Preemptive Correction of Arteriovenous Access Stenosis

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety

Authors

  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Waldron, Levi D, CUNY School of Public Health, New York, New York, United States
  • Koh, Elsie, Fresenius Vascular Care, Woodland Park, New Jersey, United States
  • Miller, Gregg, Fresenius Vascular Care, Woodland Park, New Jersey, United States
  • Sor, Murat, Fresenius Vascular Care, Woodland Park, New Jersey, United States
  • Gray, Richard J, Fresenius Vascular Care, Woodland Park, New Jersey, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

A recent meta-analysis (Ravani et al., Am J Kidney Dis 2016) studied the effect of pre-emptive correction of arterio-venous (AV) vascular access versus deferred care, based on data from 10 trials. It reported a non-significant protective treatment effect of pre-emptive correction on access loss and a significant protective effect on thrombosis rates conferred by pre-emptive correction. We revisit this analysis, including data extraction and effects of heterogeneous study populations.

Methods

We repeated data extraction from referenced publications, and corrected event counts where applicable. As a next step we repeated the meta-analyses for studies that recruited patients with AV fistulae (AVF) and grafts (AVG), using a random effects model with VA access loss as the outcome.

Results

Our conclusions differ from the original findings: After amendment of the extracted event counts we find a significant overall positive effect of pre-emptive correction on AV access loss in the overall study population [RR 0.80 (95% CI 0.64 to 0.99), RD -0.07 (95% CI -0.12 to -0.02); Figure 1]. Whereas the data do not conclusively show a benefit of pre-emptive correction for AVG (RR = 0.87, 95% CI: 0.69 – 1.11), they show a strong protective effect for AVF (RR = 0.5, 95% CI: 0.29 to 0.86).

Conclusion

These findings corroborate clinical arguments such as superior long-term patency of AVF and the nature of AVG failure that often involve infectious causes. The available data indicate mild or no benefit of pre-emptive correction for AVG, but support tight monitoring of AV dialysis accesses and preemptive intervention and correction upon the detection of access stenosis for AVF.

Figure 1: Meta-analysis of AV access loss, overall and by access type.