James Richards
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
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
Mr George Smith George.Smith@hull.ac.uk
Senior Lecturer
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
Mr George Smith George.Smith@hull.ac.uk
Senior Lecturer
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., Paul, S., Slater, M., Bartlett, M., Lagaac, R., Laing, E., Hopkins, V., Fitzpatrick-Creamer, C., Hudson, C., Parsons, J., Turner, S., Tambyraja, A., Somalanka, S., Hunter, J., Dutta, S., …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 |
Electronic 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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Publisher Licence URL
https://creativecommons.org/licenses/by-nc-nd/4.0/
Copyright Statement
© 2024 Published by Elsevier, Inc., on behalf of the International Society of Nephrology. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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