A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts

Sunanda J. Ram, Jack Work, Gloria C. Caldito, J. Mark Eason, Aslam Pervez, William D. Paulson

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

Background. It is widely accepted that hemodialysis graft surveillance combined with correction of stenosis reduces thrombosis and prolongs graft survival. Nevertheless, few randomized controlled trials have evaluated this approach. Methods. In this randomized controlled trial, 101 patients were assigned to control, flow (Qa), or stenosis groups, and were followed for up to 28 months. All patients had monthly Qa measured by ultrasound dilution and quarterly percent stenosis measured by duplex ultrasound. Referral for angiography was based on the following criteria: (1) control group (N = 34), clinical criteria; (2) flow group (N = 32), Qa <600 mL/min or clinical criteria; and (3) stenosis group (N = 35), stenosis >50% or clinical criteria. Stenosis ≥50% during angiography was corrected by preemptive percutaneous transluminal angioplasty (PTA). Results. The preemptive PTA rate in the control group (0.22/patient year) was two thirds the rate in the flow group (0.34/patient year), and was highest in the stenosis group (0.65/patient year, P < 0.01). The percentage of grafts that thrombosed was similar in the control (47%) and flow groups (53%), but reduced in the stenosis group (29%, P = 0.10). Two-year graft survival was similar in the control (62%), flow (60%), and stenosis groups (64%) (P = 0.89). Conclusion. Qa and stenosis surveillance were not associated with improved graft survival, although thrombosis was reduced in the stenosis group. The most important factors in this result may be that monthly Qa and quarterly stenosis measurements were not accurate or timely indicators of risk of thrombosis or progressive stenosis. This study does not support the concept that Qa or stenosis surveillance are superior to aggressive clinical monitoring.

Original languageEnglish (US)
Pages (from-to)272-280
Number of pages9
JournalKidney International
Volume64
Issue number1
DOIs
StatePublished - Jul 1 2003

Fingerprint

Renal Dialysis
Pathologic Constriction
Randomized Controlled Trials
Transplants
Thrombosis
Graft Survival
Angioplasty
Angiography
Control Groups
Referral and Consultation

Keywords

  • Blood flow
  • Blood vessel prosthesis
  • Cumulative survival
  • Graft surveillance
  • Hemodialysis
  • Randomized control trial
  • Stenosis
  • Thrombosis

ASJC Scopus subject areas

  • Nephrology

Cite this

A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts. / Ram, Sunanda J.; Work, Jack; Caldito, Gloria C.; Eason, J. Mark; Pervez, Aslam; Paulson, William D.

In: Kidney International, Vol. 64, No. 1, 01.07.2003, p. 272-280.

Research output: Contribution to journalArticle

Ram, Sunanda J. ; Work, Jack ; Caldito, Gloria C. ; Eason, J. Mark ; Pervez, Aslam ; Paulson, William D. / A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts. In: Kidney International. 2003 ; Vol. 64, No. 1. pp. 272-280.
@article{948c4ff16d434051af913b73d4feb29f,
title = "A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts",
abstract = "Background. It is widely accepted that hemodialysis graft surveillance combined with correction of stenosis reduces thrombosis and prolongs graft survival. Nevertheless, few randomized controlled trials have evaluated this approach. Methods. In this randomized controlled trial, 101 patients were assigned to control, flow (Qa), or stenosis groups, and were followed for up to 28 months. All patients had monthly Qa measured by ultrasound dilution and quarterly percent stenosis measured by duplex ultrasound. Referral for angiography was based on the following criteria: (1) control group (N = 34), clinical criteria; (2) flow group (N = 32), Qa <600 mL/min or clinical criteria; and (3) stenosis group (N = 35), stenosis >50{\%} or clinical criteria. Stenosis ≥50{\%} during angiography was corrected by preemptive percutaneous transluminal angioplasty (PTA). Results. The preemptive PTA rate in the control group (0.22/patient year) was two thirds the rate in the flow group (0.34/patient year), and was highest in the stenosis group (0.65/patient year, P < 0.01). The percentage of grafts that thrombosed was similar in the control (47{\%}) and flow groups (53{\%}), but reduced in the stenosis group (29{\%}, P = 0.10). Two-year graft survival was similar in the control (62{\%}), flow (60{\%}), and stenosis groups (64{\%}) (P = 0.89). Conclusion. Qa and stenosis surveillance were not associated with improved graft survival, although thrombosis was reduced in the stenosis group. The most important factors in this result may be that monthly Qa and quarterly stenosis measurements were not accurate or timely indicators of risk of thrombosis or progressive stenosis. This study does not support the concept that Qa or stenosis surveillance are superior to aggressive clinical monitoring.",
keywords = "Blood flow, Blood vessel prosthesis, Cumulative survival, Graft surveillance, Hemodialysis, Randomized control trial, Stenosis, Thrombosis",
author = "Ram, {Sunanda J.} and Jack Work and Caldito, {Gloria C.} and Eason, {J. Mark} and Aslam Pervez and Paulson, {William D.}",
year = "2003",
month = "7",
day = "1",
doi = "10.1046/j.1523-1755.2003.00070.x",
language = "English (US)",
volume = "64",
pages = "272--280",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "1",

}

TY - JOUR

T1 - A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts

AU - Ram, Sunanda J.

AU - Work, Jack

AU - Caldito, Gloria C.

AU - Eason, J. Mark

AU - Pervez, Aslam

AU - Paulson, William D.

PY - 2003/7/1

Y1 - 2003/7/1

N2 - Background. It is widely accepted that hemodialysis graft surveillance combined with correction of stenosis reduces thrombosis and prolongs graft survival. Nevertheless, few randomized controlled trials have evaluated this approach. Methods. In this randomized controlled trial, 101 patients were assigned to control, flow (Qa), or stenosis groups, and were followed for up to 28 months. All patients had monthly Qa measured by ultrasound dilution and quarterly percent stenosis measured by duplex ultrasound. Referral for angiography was based on the following criteria: (1) control group (N = 34), clinical criteria; (2) flow group (N = 32), Qa <600 mL/min or clinical criteria; and (3) stenosis group (N = 35), stenosis >50% or clinical criteria. Stenosis ≥50% during angiography was corrected by preemptive percutaneous transluminal angioplasty (PTA). Results. The preemptive PTA rate in the control group (0.22/patient year) was two thirds the rate in the flow group (0.34/patient year), and was highest in the stenosis group (0.65/patient year, P < 0.01). The percentage of grafts that thrombosed was similar in the control (47%) and flow groups (53%), but reduced in the stenosis group (29%, P = 0.10). Two-year graft survival was similar in the control (62%), flow (60%), and stenosis groups (64%) (P = 0.89). Conclusion. Qa and stenosis surveillance were not associated with improved graft survival, although thrombosis was reduced in the stenosis group. The most important factors in this result may be that monthly Qa and quarterly stenosis measurements were not accurate or timely indicators of risk of thrombosis or progressive stenosis. This study does not support the concept that Qa or stenosis surveillance are superior to aggressive clinical monitoring.

AB - Background. It is widely accepted that hemodialysis graft surveillance combined with correction of stenosis reduces thrombosis and prolongs graft survival. Nevertheless, few randomized controlled trials have evaluated this approach. Methods. In this randomized controlled trial, 101 patients were assigned to control, flow (Qa), or stenosis groups, and were followed for up to 28 months. All patients had monthly Qa measured by ultrasound dilution and quarterly percent stenosis measured by duplex ultrasound. Referral for angiography was based on the following criteria: (1) control group (N = 34), clinical criteria; (2) flow group (N = 32), Qa <600 mL/min or clinical criteria; and (3) stenosis group (N = 35), stenosis >50% or clinical criteria. Stenosis ≥50% during angiography was corrected by preemptive percutaneous transluminal angioplasty (PTA). Results. The preemptive PTA rate in the control group (0.22/patient year) was two thirds the rate in the flow group (0.34/patient year), and was highest in the stenosis group (0.65/patient year, P < 0.01). The percentage of grafts that thrombosed was similar in the control (47%) and flow groups (53%), but reduced in the stenosis group (29%, P = 0.10). Two-year graft survival was similar in the control (62%), flow (60%), and stenosis groups (64%) (P = 0.89). Conclusion. Qa and stenosis surveillance were not associated with improved graft survival, although thrombosis was reduced in the stenosis group. The most important factors in this result may be that monthly Qa and quarterly stenosis measurements were not accurate or timely indicators of risk of thrombosis or progressive stenosis. This study does not support the concept that Qa or stenosis surveillance are superior to aggressive clinical monitoring.

KW - Blood flow

KW - Blood vessel prosthesis

KW - Cumulative survival

KW - Graft surveillance

KW - Hemodialysis

KW - Randomized control trial

KW - Stenosis

KW - Thrombosis

UR - http://www.scopus.com/inward/record.url?scp=0038468806&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038468806&partnerID=8YFLogxK

U2 - 10.1046/j.1523-1755.2003.00070.x

DO - 10.1046/j.1523-1755.2003.00070.x

M3 - Article

C2 - 12787419

AN - SCOPUS:0038468806

VL - 64

SP - 272

EP - 280

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 1

ER -