NDT Advance Access originally published online on July 19, 2006
Nephrology Dialysis Transplantation 2006 21(9):2498-2506; doi:10.1093/ndt/gfl242
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Does monthly native arteriovenous fistula blood-flow surveillance detect significant stenosis—a randomized controlled trial
1 Departments of Nephrology, 2 Department of Radiology and 3 Department of Surgery, Monash Medical Centre, Melbourne, Victoria 3168, Australia
Correspondence and offprint requests to: Dr K. R. Polkinghorne, Department of Nephrology, Monash Medical Centre, 246 Clayton Rd, Clayton, Melbourne, Victoria 3168, Australia. Email: kevan.polkinghorne{at}med.monash.edu.au
Background. Clinical practice guidelines recommend that the preferred method of surveillance for arteriovenous fistula (AVF) is the measurement of AVF blood flow (Qa). As these recommendations are based on observational studies, we conducted a randomized, prospective, double-blind, controlled trial to assess whether Qa surveillance results in an increased detection of AVF stenosis.
Methods. A total of 137 patients were randomly assigned to receive either continuing AVF surveillance using current clinical criteria (control, usual treatment) or usual treatment plus AVF blood-flow surveillance by ultrasound dilution (Qa surveillance group). The primary outcome measure was the detection of a significant (>50%) AVF stenosis.
Results. There were 67 and 68 patients assigned to the control and Qa surveillance groups, respectively. Patients in the Qa surveillance group were twice as likely to have a stenosis detected compared with the control hazard ratio (HR) confidence interval (CI) group (2.27, 95% 0.85–5.98, P = 0.09), with a trend for a significant stenosis to be detected earlier in the Qa surveillance group (P = 0.09, log rank test). However, using the Qa results alone prior to angiography, the area under the receiver operating characteristic curve demonstrated, at best, a moderate prediction of (>50%) AVF stenosis (0.78, 95% CI 0.63–0.94, P = 0.006).
Conclusion. This study demonstrates that the addition of AVF Qa monitoring to clinical screening for AVF stenosis resulted in a non-significant doubling in the detection of angiographically significant AVF stenosis. Further, large multi-centre randomized trials are feasible and will be necessary to confirm whether Qa surveillance and the correction of detected AVF stenosis will lead to a reduction in AVF thrombosis and increased AVF survival.
Keywords: access blood flow; native fistula; randomized trial; surveillance
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