title: A meta-analysis of randomized clinical trials assessing hemodialysis access thrombosis based on access flow monitoring: where do we stand?
abstract: The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends the routine use of hemodialysis arteriovenous (AV) access surveillance to detect hemodynamically significant stenoses and appropriately correct them to reduce the incidence of thrombosis and to improve accesses patency rates. Access blood flow monitoring is considered as one of the preferred surveillance method for both AV fistulas (AVF) and AV grafts (AVG); however, published studies have reported conflicting results of its utility that led healthcare professionals to doubt the benefits of this surveillance method. We performed a meta-analysis of the published randomized controlled trials (RCTs) of AV access surveillance using access blood flow monitoring. Our hypothesis was that access blood flow monitoring lowers the risk of AV access thrombosis and that the outcome differs between AVF and AVG. The estimated overall pooled risk ratio (RR) of thrombosis was 0.87 (95% confidence interval [CI], 0.67-1.13) favoring access blood flow monitoring. The pooled RR of thrombosis were 0.64 (95% CI, 0.41-1.01) and 1.06 (95% CI, 0.77-1.46) in the subgroups of only AVF and only AVG, respectively. Our results added to the uncertainty of access blood flow monitoring as a surveillance method of hemodialysis accesses.
authors: Medicine/Nephrology, University of Miami, Miami, Florida.
authors: Timothy
authors: T
authors: Muchayi
authors: Loay
authors: L
authors: Salman
authors: Leonardo J
authors: LJ
authors: Tamariz
authors: Arif
authors: A
authors: Asif
authors: Abid
authors: A
authors: Rizvi
authors: Oliver
authors: O
authors: Lenz
authors: Roberto I
authors: RI
authors: Vazquez-Padron
authors: Marwan
authors: M
authors: Tabbara
authors: Gabriel
authors: G
authors: Contreras
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008991:Monitoring, Physiologic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013927:Thrombosis / Q000503:physiopathology*
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