Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula.

Autor:	Richards J; Addenbrooke's Hospital, Hill Road, Cambridge, UK.; University of Cambridge, Hill Road, Cambridge, UK.; Royal Free London NHS Foundation Trust, London, UK., Summers D; Addenbrooke's Hospital, Hill Road, Cambridge, UK.; University of Cambridge, Hill Road, Cambridge, UK., Sidders A; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Allen E; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Thomas H; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Hossain MA; Royal Free London NHS Foundation Trust, London, UK., Paul S; Addenbrooke's Hospital, Hill Road, Cambridge, UK.; University of Cambridge, Hill Road, Cambridge, UK., Slater M; Addenbrooke's Hospital, Hill Road, Cambridge, UK., Bartlett M; Royal Free London NHS Foundation Trust, London, UK., Lagaac R; Addenbrooke's Hospital, Hill Road, Cambridge, UK., Laing E; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Hopkins V; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Fitzpatrick-Creamer C; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Hudson C; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Parsons J; NHS Blood and Transplant Clinical Trials Unit, Cambridge, UK., Turner S; North Bristol NHS Trust, Bristol, UK., Tambyraja A; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK., Somalanka S; Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK., Hunter J; University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK., Dutta S; Nottingham University Hospitals NHS Trust, Nottingham, UK., Hoye N; South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK., Lawman S; Brighton and Sussex University Hospitals NHS Trust, Worthing, West Sussex, UK., Salter T; Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.; Frimley Health NHS Foundation Trust, Camberley, Surrey, UK., Aslam M; Imperial College Healthcare NHS Trust, London, UK., Bagul A; University Hospitals of Leicester NHS Trust, Leicester, UK., Sivaprakasam R; Bart's Health NHS Trust, London, UK., Smith G; Hull University Teaching Hospitals NHS Trust, Hull, UK., Moinuddin Z; Manchester University NHS Foundation Trust, Manchester, UK., Knight S; Oxford University Hospitals NHS Foundation Trust, Headington Oxford, UK., Barnett N; Guy's and St Thomas' NHS Foundation Trust, London, UK., Motallebzadeh R; Royal Free London NHS Foundation Trust, London, UK., Pettigrew GJ; Addenbrooke's Hospital, Hill Road, Cambridge, UK.; University of Cambridge, Hill Road, Cambridge, UK.
Jazyk:	angličtina
Zdroj:	Kidney international reports [Kidney Int Rep] 2024 Jan 05; Vol. 9 (4), pp. 1005-1019. Date of Electronic Publication: 2024 Jan 05 (Print Publication: 2024).
DOI:	10.1016/j.ekir.2024.01.011
Abstrakt:	Introduction: We assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention. Methods: Consenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling. Results: Of 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9-77.3]; elbow, 66.7% [48.9-84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan's findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data. Conclusion: Early ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation. (© 2024 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.)
Databáze:	MEDLINE
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