Abstract: FR-PO524
Software-Based Surveillance Supplementing Clinical Monitoring for Hemodialysis Vascular Access
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Poulikakos, Dimitrios J., Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Donne, Rosemary L., Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Lewis, David M., Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Raman, Maharajan, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Pondor, Zulfikar Ali, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Hinchliffe, Paul Simon, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Cowperthwaite, Jan, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Lim, Jazzle, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Gleave, Paula J., Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Allsopp, Jonathan, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Resiga, Marinela Liliana, Northern Care Alliance NHS Foundation Trust Salford Care Organisation, Salford, Greater Manchester, United Kingdom
- Eltahan, Alshymaa Rafiek, Helwan University, Helwan, Cairo, Egypt
Background
Efficient arteriovenous access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units.
Methods
We conducted a 12-month prospective study on maintenance hemodialysis (HD) patients, using Vasc-Alert software for clinical decision-making in 2 satellite HD units (Group 1), while providing standard care in 3 other HD units (Group 2). Patients with high Vasc-Alert access risk scores (≥7) received clinical assessments and were referred for fistulogram based on Kidney Disease Outcome Quality Initiative (KDOQI) criteria. We collected data on referrals for fistulograms, preemptive stenosis corrections, avoidable thrombosis (defined as thrombosis occurring while waiting for elective stenosis correction), and VA-related costs. We also measured the post-intervention primary patency rate.
Results
In Group 1, there were 23 (28.1%) preemptive stenosis corrections and 6 (7.3%) thrombosis episodes, while Group 2 had 40 (19.5%) corrections and 21 (10.2%) episodes (p = 0.155 and 0.587, respectively). Avoidable thrombosis occurred in 83% of Group 1 compared to 19% in Group 2 (p = 0.004). The median time from fistulogram request to thrombosed VA was 26 days. Group 1 showed better post-intervention primary patency rates (p < 0.001). The average VA-related cost per patient was £1600 for Group 1 and £1868 for Group 2.
Conclusion
Supplementing clinical surveillance with Vasc-Alert technology was associated with improved early detection of high-risk VA and higher primary patency rates, Improving elective interventional radiology (IR) capacity for timely intervention is crucial to materialize the benefits of enhanced surveillance.