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A Meta‐analysis of Randomized Clinical Trials Assessing Hemodialysis Access Thrombosis Based on Access Flow Monitoring: Where Do We Stand?
Author(s) -
Muchayi Timothy,
Salman Loay,
Tamariz Leonardo J.,
Asif Arif,
Rizvi Abid,
Lenz Oliver,
VazquezPadron Roberto I.,
Tabbara Marwan,
Contreras Gabriel
Publication year - 2015
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12342
Subject(s) - medicine , hemodialysis , randomized controlled trial , thrombosis , confidence interval , vascular access , incidence (geometry) , relative risk , emergency medicine , meta analysis , intensive care medicine , surgery , physics , optics
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 ( RCT s) 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.