Random Controlled Study Indicates Benefit to Early Intervention

Oxford_Study_Graph_2014

A recent random controlled study demonstrates that intervention in an access with >50% stenosis is beneficial even in accesses that have adequate blood flow and no other clinical indicators of dysfunction (persistent cannulation issues, excessive bleeding post treatment, spKt/V<1.2 or decreased blood flow due to high pressures during treatment). This is proven out by a greater than 2-fold increase in AVF access survival after 5 years (30% vs 72%), and a 3-fold decrease in access loss rate (0.186 vs 0.066).

In addition, the costs associated with each arm of the study were essentially even, meaning that the higher number of elective stenosis repairs in the treatment group was balanced by a lower cost of CVC insertions, hospitalizations, thrombectomy procedures and access replacement in the control group.

The authors state that at the time of the study design they were unaware that “measuring VAPR was more useful than Qa in detecting outflow stenosis.” There were 3 AVF thrombotic and/or loss of access events where the incidences were preceded by an increase in VAPR (indicating increasing stenosis), although there was no drop in blood flow (Qa).  Vasc-Alert derives VAPR as part of their standard reporting.

This 6 year random controlled study establishes the core argument for better and more aggressive access care leading to longer access survival rates and fewer hospitalizations.

Tessitore N, Bedogna V et al. “Should current criteria for detecting and repairing arteriovenous fistula stenosis be reconsidered? Interim analysis of a randomized controlled trial.” Nephrol. Dial. Transplant 29.1 (2014): 179-187.

For the abstract and further information see:

http://ndt.oxfordjournals.org/content/29/1/179.abstract?sid=8483d18b-9cf6-4546-a434-041daf705470