Access monitoring does not really improve outcomes.
It is widely accepted that hemodialysis access monitoring combined with preemptive percutaneous transluminal angioplasty (PTA) improves outcomes. The many studies that have evaluated monitoring during the last decade provide an opportunity to examine whether this hypothesis is valid. Because synthetic grafts are more likely than autogenous arteriovenous fistulas to benefit from monitoring, this review is restricted to grafts. Recent studies show that monitoring does not accurately predict graft thrombosis or failure, nor does it prolong graft life. However, monitoring can reduce thrombosis, and thereby reduce access-related hospitalizations and use of central venous dialysis catheters. Because preemptive PTA is expensive, however, monitoring does not reduce the cost of access-related care. The limited benefit that monitoring provides emphasizes the urgent need to develop better approaches to solving the problem of graft thrombosis and failure.
Paulson
William D
WD
Section of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, Medical College of Georgia, Augusta, GA 30912-3140, USA. wpaulson@mcg.edu
D015906:Angioplasty, Balloon, Coronary; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000592:standards*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy