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Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

Richards, James; Summers, Dominic; Sidders, Anna; Allen, Elisa; Thomas, Helen; Hossain, Mohammed Ayaz; Paul, Subhankar; Slater, Matthew; Bartlett, Matthew; Lagaac, Regin; Laing, Emma; Hopkins, Valerie; Fitzpatrick-Creamer, Chloe; Hudson, Cara; Parsons, Joseph; Turner, Sam; Tambyraja, Andrew; Somalanka, Subash; Hunter, James; Dutta, Sam; Hoye, Neil; Lawman, Sarah; Salter, Tracey; Aslam, Mohammed; Bagul, Atul; Sivaprakasam, Rajesh; Smith, George; Moinuddin, Zia; Knight, Simon; Barnett, Nicholas; Motallebzadeh, Reza; Pettigrew, Gavin J.; Sidders, Anna; Hudson, Cara; Foley, Claire; Hopkins, Valerie; Laing, Emma; Fitzpatrick-Creamer, Chloe; Thomas, Helen; Deary, Alison; Pettigrew, Gavin J.; Richards, James; Hossain, Mohammed; Summers, Dominic; Slater, Matthew; Scott, Laura; Lagaac, Regin; Surendrakumar, Veena; Ayorinde, Tobi; Chipurovski, Igor; Kathirvel, Manikandan; Thialli, Manoj; Paul, Subhankar; Norton, Andrew; Knight, Simon; Bond, Klaus; Hardy, Elizabeth; Widdup, Joanne; Potter, Rachae...

Authors

James Richards

Dominic Summers

Anna Sidders

Elisa Allen

Helen Thomas

Mohammed Ayaz Hossain

Subhankar Paul

Matthew Slater

Matthew Bartlett

Regin Lagaac

Emma Laing

Valerie Hopkins

Chloe Fitzpatrick-Creamer

Cara Hudson

Joseph Parsons

Sam Turner

Andrew Tambyraja

Subash Somalanka

James Hunter

Sam Dutta

Neil Hoye

Sarah Lawman

Tracey Salter

Mohammed Aslam

Atul Bagul

Rajesh Sivaprakasam

Zia Moinuddin

Simon Knight

Nicholas Barnett

Reza Motallebzadeh

Gavin J. Pettigrew

Anna Sidders

Cara Hudson

Claire Foley

Valerie Hopkins

Emma Laing

Chloe Fitzpatrick-Creamer

Helen Thomas

Alison Deary

Gavin J. Pettigrew

James Richards

Mohammed Hossain

Dominic Summers

Matthew Slater

Laura Scott

Regin Lagaac

Veena Surendrakumar

Tobi Ayorinde

Igor Chipurovski

Manikandan Kathirvel

Manoj Thialli

Subhankar Paul

Andrew Norton

Simon Knight

Klaus Bond

Elizabeth Hardy

Joanne Widdup

Rachael Potter

Elisabeth Pugh

Karen Parsons

Kathryn Lafferty

Madita Gavrila

Sheera Sutherland

Ria Rabara

Rajesh Sivaprakasam

Kate Crawford

Amy Bolsworth

Naavalah Ngwa-Ndifor

Laura Clementoni

Reza Motallebzadeh

Mohammad Ayaz Hossain

Matthew Bartlett

Rani Badhan

Fernando Yuenchang

Phil Gardiner

Natasha Irani

Zia Moinuddin

Helena Edlin

Anna Jerram

Jessica Lai

Joyce Banda

Janet Bendle

Sam Turner

Maria Morgan

William Owen

Sue Dawson

Simon Daniel

Karen Allsop

Andrew Tambyraja

Sarah-Jane Carmichael

Tom Eadie

Rona Lochiel

Midel Lena

Karen Gallagher

Nicholas Barnett

Soundrie Padayachee

Philip Eldridge

May Rabuya

Naomi Hare

Subash Somalanka

Jashree Patel

Abbas Ghazanfar

Judy van Selm

Caroline Bodneck

Martia Augustin

Kwame Ansu

Nalin Khosla

Kashif Burney

Karen Dear

Duminda Basnayake

Laijee Benny

James Hunter

Carl Tiivas

Samantha Hyndman

Maria Truslove

Gail Evans

Kerry Read

Sam Dutta

Andrew Beech

Sarah Brand

Tara MacCormick-Swanson

Sarah Lawman

Darren Cheal

Mel Smith

Kate Trivedi

Valentina Toska

Lorraine Shah-Goodwin

Tracey Salter

Adnan Bajwa

John Kerr

Ana Fleet

Lianne Chapman

Sarah Gee

Thanuja Weerasinghe

Lisa Kavanagh

Louise Rowe-Leete

Paris Cai

Judith Long

Tracey Rowe

Mohammed Aslam

Jeremy Crane

Atul Bagul

Mary Quashie-Akponeware

Kate Waters

Alexandra Howson

Neil Hoye

Alycon Walker



Abstract

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.

Citation

Richards, J., Summers, D., Sidders, A., Allen, E., Thomas, H., Hossain, M. A., …Walker, A. (2024). Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula. Kidney International Reports, 9(4), 1005-1019. https://doi.org/10.1016/j.ekir.2024.01.011

Journal Article Type Article
Acceptance Date Jan 2, 2024
Online Publication Date Jan 5, 2024
Publication Date Apr 1, 2024
Deposit Date Jan 9, 2024
Publicly Available Date Apr 5, 2024
Journal Kidney International Reports
Print ISSN 2468-0249
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 9
Issue 4
Pages 1005-1019
DOI https://doi.org/10.1016/j.ekir.2024.01.011
Keywords Arteriovenous fistula; Renal dialysis; Ultrasonography; Doppler; Kidney failure; chronic: Haemodialysis; Vascular access surgery
Public URL https://hull-repository.worktribe.com/output/4508478

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