Surveillance of arteriovenous hemodialysis access: A systematic review and meta-analysis

Edward T. Casey, Mohammad H Murad, Adnan Z. Rizvi, Anton N. Sidawy, Martina M. McGrath, Mohamed B. Elamin, David N. Flynn, Finnian R. McCausland, Danny H. Vo, Ziad M El-Zoghby, Audra A. Duncan, Michal J. Tracz, Patricia J. Erwin, Victor Manuel Montori

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objectives: Hemodialysis centers regularly survey arteriovenous (AV) accesses for signs of dysfunction. In this review, we synthesize the available evidence to determine to what extent proactive vascular access monitoring affects the incidence of AV access thrombosis and abandonment compared with clinical monitoring. Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and SCOPUS) and sought references from experts, bibliographies of included trials, and articles that cited included studies. Two reviewers independently assessed trial quality and extracted data. We used random effects meta-analysis to estimate the pooled relative risk (RR) and 95% confidence interval (CI) across studies and conducted subgroup analyses to explain heterogeneity. The I2 statistic was used to assess heterogeneity of treatment effect among trials. Results: Nine studies (1363 patients) compared a strategy of surveillance vs clinical monitoring. A vascular intervention to maintain or restore patency was provided to both groups if needed. Surveillance followed by intervention led to a nonsignificant reduction of the risk of access thrombosis (RR, 0.82; 95% CI, 0.58-1.16; I2 = 37%) and access abandonment (RR, 0.80; 95% CI, 0.51-1.25; I2 = 60%). Three studies (207 patients) compared the effect of vascular interventions vs observation in patients with abnormal surveillance result. Vascular interventions after an abnormal AV access surveillance led to a significant reduction of the risk of access thrombosis (RR, 0.53; 95% CI, 0.36-0.76) and a nonsignificant reduction of the risk of access abandonment (RR, 0.76; 95% CI, 0.43-1.37). Conclusion: Very low quality evidence yielding imprecise results suggests a potentially beneficial effect of AV access surveillance followed by interventions to restore patency. This inference, however, is weak and will require randomized trials of AV access surveillance vs clinical monitoring for rejection or confirmation.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
Volume48
Issue number5 SUPPL.
DOIs
StatePublished - Nov 2008

Fingerprint

Renal Dialysis
Meta-Analysis
Blood Vessels
Confidence Intervals
Risk Reduction Behavior
Thrombosis
Bibliography
MEDLINE
Observation
Databases
Incidence
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Surveillance of arteriovenous hemodialysis access : A systematic review and meta-analysis. / Casey, Edward T.; Murad, Mohammad H; Rizvi, Adnan Z.; Sidawy, Anton N.; McGrath, Martina M.; Elamin, Mohamed B.; Flynn, David N.; McCausland, Finnian R.; Vo, Danny H.; El-Zoghby, Ziad M; Duncan, Audra A.; Tracz, Michal J.; Erwin, Patricia J.; Montori, Victor Manuel.

In: Journal of Vascular Surgery, Vol. 48, No. 5 SUPPL., 11.2008.

Research output: Contribution to journalArticle

Casey, ET, Murad, MH, Rizvi, AZ, Sidawy, AN, McGrath, MM, Elamin, MB, Flynn, DN, McCausland, FR, Vo, DH, El-Zoghby, ZM, Duncan, AA, Tracz, MJ, Erwin, PJ & Montori, VM 2008, 'Surveillance of arteriovenous hemodialysis access: A systematic review and meta-analysis', Journal of Vascular Surgery, vol. 48, no. 5 SUPPL.. https://doi.org/10.1016/j.jvs.2008.08.043
Casey, Edward T. ; Murad, Mohammad H ; Rizvi, Adnan Z. ; Sidawy, Anton N. ; McGrath, Martina M. ; Elamin, Mohamed B. ; Flynn, David N. ; McCausland, Finnian R. ; Vo, Danny H. ; El-Zoghby, Ziad M ; Duncan, Audra A. ; Tracz, Michal J. ; Erwin, Patricia J. ; Montori, Victor Manuel. / Surveillance of arteriovenous hemodialysis access : A systematic review and meta-analysis. In: Journal of Vascular Surgery. 2008 ; Vol. 48, No. 5 SUPPL.
@article{f0371ade0f7b4c69a45488585cd8f59d,
title = "Surveillance of arteriovenous hemodialysis access: A systematic review and meta-analysis",
abstract = "Objectives: Hemodialysis centers regularly survey arteriovenous (AV) accesses for signs of dysfunction. In this review, we synthesize the available evidence to determine to what extent proactive vascular access monitoring affects the incidence of AV access thrombosis and abandonment compared with clinical monitoring. Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and SCOPUS) and sought references from experts, bibliographies of included trials, and articles that cited included studies. Two reviewers independently assessed trial quality and extracted data. We used random effects meta-analysis to estimate the pooled relative risk (RR) and 95{\%} confidence interval (CI) across studies and conducted subgroup analyses to explain heterogeneity. The I2 statistic was used to assess heterogeneity of treatment effect among trials. Results: Nine studies (1363 patients) compared a strategy of surveillance vs clinical monitoring. A vascular intervention to maintain or restore patency was provided to both groups if needed. Surveillance followed by intervention led to a nonsignificant reduction of the risk of access thrombosis (RR, 0.82; 95{\%} CI, 0.58-1.16; I2 = 37{\%}) and access abandonment (RR, 0.80; 95{\%} CI, 0.51-1.25; I2 = 60{\%}). Three studies (207 patients) compared the effect of vascular interventions vs observation in patients with abnormal surveillance result. Vascular interventions after an abnormal AV access surveillance led to a significant reduction of the risk of access thrombosis (RR, 0.53; 95{\%} CI, 0.36-0.76) and a nonsignificant reduction of the risk of access abandonment (RR, 0.76; 95{\%} CI, 0.43-1.37). Conclusion: Very low quality evidence yielding imprecise results suggests a potentially beneficial effect of AV access surveillance followed by interventions to restore patency. This inference, however, is weak and will require randomized trials of AV access surveillance vs clinical monitoring for rejection or confirmation.",
author = "Casey, {Edward T.} and Murad, {Mohammad H} and Rizvi, {Adnan Z.} and Sidawy, {Anton N.} and McGrath, {Martina M.} and Elamin, {Mohamed B.} and Flynn, {David N.} and McCausland, {Finnian R.} and Vo, {Danny H.} and El-Zoghby, {Ziad M} and Duncan, {Audra A.} and Tracz, {Michal J.} and Erwin, {Patricia J.} and Montori, {Victor Manuel}",
year = "2008",
month = "11",
doi = "10.1016/j.jvs.2008.08.043",
language = "English (US)",
volume = "48",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "5 SUPPL.",

}

TY - JOUR

T1 - Surveillance of arteriovenous hemodialysis access

T2 - A systematic review and meta-analysis

AU - Casey, Edward T.

AU - Murad, Mohammad H

AU - Rizvi, Adnan Z.

AU - Sidawy, Anton N.

AU - McGrath, Martina M.

AU - Elamin, Mohamed B.

AU - Flynn, David N.

AU - McCausland, Finnian R.

AU - Vo, Danny H.

AU - El-Zoghby, Ziad M

AU - Duncan, Audra A.

AU - Tracz, Michal J.

AU - Erwin, Patricia J.

AU - Montori, Victor Manuel

PY - 2008/11

Y1 - 2008/11

N2 - Objectives: Hemodialysis centers regularly survey arteriovenous (AV) accesses for signs of dysfunction. In this review, we synthesize the available evidence to determine to what extent proactive vascular access monitoring affects the incidence of AV access thrombosis and abandonment compared with clinical monitoring. Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and SCOPUS) and sought references from experts, bibliographies of included trials, and articles that cited included studies. Two reviewers independently assessed trial quality and extracted data. We used random effects meta-analysis to estimate the pooled relative risk (RR) and 95% confidence interval (CI) across studies and conducted subgroup analyses to explain heterogeneity. The I2 statistic was used to assess heterogeneity of treatment effect among trials. Results: Nine studies (1363 patients) compared a strategy of surveillance vs clinical monitoring. A vascular intervention to maintain or restore patency was provided to both groups if needed. Surveillance followed by intervention led to a nonsignificant reduction of the risk of access thrombosis (RR, 0.82; 95% CI, 0.58-1.16; I2 = 37%) and access abandonment (RR, 0.80; 95% CI, 0.51-1.25; I2 = 60%). Three studies (207 patients) compared the effect of vascular interventions vs observation in patients with abnormal surveillance result. Vascular interventions after an abnormal AV access surveillance led to a significant reduction of the risk of access thrombosis (RR, 0.53; 95% CI, 0.36-0.76) and a nonsignificant reduction of the risk of access abandonment (RR, 0.76; 95% CI, 0.43-1.37). Conclusion: Very low quality evidence yielding imprecise results suggests a potentially beneficial effect of AV access surveillance followed by interventions to restore patency. This inference, however, is weak and will require randomized trials of AV access surveillance vs clinical monitoring for rejection or confirmation.

AB - Objectives: Hemodialysis centers regularly survey arteriovenous (AV) accesses for signs of dysfunction. In this review, we synthesize the available evidence to determine to what extent proactive vascular access monitoring affects the incidence of AV access thrombosis and abandonment compared with clinical monitoring. Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and SCOPUS) and sought references from experts, bibliographies of included trials, and articles that cited included studies. Two reviewers independently assessed trial quality and extracted data. We used random effects meta-analysis to estimate the pooled relative risk (RR) and 95% confidence interval (CI) across studies and conducted subgroup analyses to explain heterogeneity. The I2 statistic was used to assess heterogeneity of treatment effect among trials. Results: Nine studies (1363 patients) compared a strategy of surveillance vs clinical monitoring. A vascular intervention to maintain or restore patency was provided to both groups if needed. Surveillance followed by intervention led to a nonsignificant reduction of the risk of access thrombosis (RR, 0.82; 95% CI, 0.58-1.16; I2 = 37%) and access abandonment (RR, 0.80; 95% CI, 0.51-1.25; I2 = 60%). Three studies (207 patients) compared the effect of vascular interventions vs observation in patients with abnormal surveillance result. Vascular interventions after an abnormal AV access surveillance led to a significant reduction of the risk of access thrombosis (RR, 0.53; 95% CI, 0.36-0.76) and a nonsignificant reduction of the risk of access abandonment (RR, 0.76; 95% CI, 0.43-1.37). Conclusion: Very low quality evidence yielding imprecise results suggests a potentially beneficial effect of AV access surveillance followed by interventions to restore patency. This inference, however, is weak and will require randomized trials of AV access surveillance vs clinical monitoring for rejection or confirmation.

UR - http://www.scopus.com/inward/record.url?scp=55449098783&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55449098783&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2008.08.043

DO - 10.1016/j.jvs.2008.08.043

M3 - Article

C2 - 19000593

AN - SCOPUS:55449098783

VL - 48

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 5 SUPPL.

ER -