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Kidney Week

Abstract: PO1348

Hemodialysis Access Surveillance Evaluation (HASE) Study

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Salman, Loay H., Albany Medical College, Albany, New York, United States
  • Rizvi, Abid A., California Kidney Specialists, San Dimas, California, United States
  • Contreras, Gabriel, University of Miami School of Medicine, Miami, Florida, United States
  • Manning, Christina E., Albany Medical College, Albany, New York, United States
  • Feustel, Paul J., Albany Medical College, Albany, New York, United States
  • Machado, Ivy, University of Miami School of Medicine, Miami, Florida, United States
  • Briones, Patricia Larrieu, University of Miami School of Nursing and Health Studies, Coral Gables, Florida, United States
  • Jamal, Aamir Z., California Kidney Specialists, San Dimas, California, United States
  • Bateman, Nicolle, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Martinez, Laisel, University of Miami School of Medicine, Miami, Florida, United States
  • Vazquez-Padron, Roberto I., University of Miami School of Medicine, Miami, Florida, United States
  • Asif, Arif, Jersey Shore University Medical Center, Neptune City, New Jersey, United States
Background

Arteriovenous (AV) access thrombosis remains one of the most troubling AV access related complication affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk AV access loss. The routine use of AV access surveillance for early detection and management of stenosis to reduce thrombosis remains controversial.

Methods

We conducted a multicenter, prospective, randomized clinical trial comparing standard of care with monthly Ultrasound Dilution Technique (UDT) flow surveillance using a Transonic flow measurement device (Transonic Systems Inc., 34 Dutch Mill Road, Ithaca, NY 14850, USA) to standard of care alone.

Results

We prospectively randomized 436 patients with end stage renal disease (ESRD) on hemodialysis with arteriovenous fistula (AVF) or graft (AVG) using cluster (i.e. dialysis shift) randomization to either standard of care with monthly blood flow surveillance or standard of care alone. There were no statistically significant differences in the baseline demographic data between the two 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) as compared to the control group (0.23/patient) (p=0.012). There was no significant difference in total number of procedures between the two groups, irrespective of whether thrombectomy procedures were included or excluded. There was no statistically significant difference between the two groups in the rate of or the time to a first thrombotic event or number of catheters placed due to thrombosis.

Conclusion

The use of monthly AV access surveillance with UDT flow measurement in this multicenter randomized control 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.


Funding
Transonic Systems Inc., 34 Dutch Mill Road, Ithaca, NY 14850, USA