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Development and validation of a risk score to prioritize patients for evaluation of access stenosis
Author(s) -
Astor Brad C.,
Hirschman Kim,
Kennedy John,
Frinak Stan,
Besarab Anatole
Publication year - 2021
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.13026
Subject(s) - medicine , psychological intervention , referral , hemodialysis , stenosis , physical therapy , emergency medicine , family medicine , psychiatry
Background Access flow dysfunction, often associated with stenosis, is a common problem in hemodialysis access and may result in progression to thrombosis. Timely identification of accesses in need of evaluation is critical to preserving a functioning access. We hypothesized that a risk score using measurements obtained from the Vasc‐Alert surveillance device could be used to predict subsequent interventions. Methods Measurement of five factors over the preceding 28 days from 1.46 million hemodialysis treatments (6163 patients) were used to develop a score associated with interventions over the subsequent 60 days. The score was validated in a separate dataset of 298,620 treatments (2641 patients). Results Interventions in arteriovenous fistulae (AVF; n = 4125) were much more common in those with the highest score (36.2%) than in those with the lowest score (11.0). The score also was strongly associated with interventions in patients with an arteriovenous graft (AVG; n = 2,038; 43.2% vs. 21.1%). There was excellent agreement in the Validation datasets for AVF (OR = 2.67 comparing the highest to lowest score) and good agreement for AVG (OR = 1.92). Conclusions This simple risk score based on surveillance data may be useful for prioritizing patients for physical examination and potentially early referral for intervention.