Hemodialysis Access Surveillance

Abstract

Vascular access (VA) care is considered the “Achilles heel” for the success of hemodialysis operation. Early detection of VA stenosis remains a major challenge for clinical nephrologists. Various studies tried to create methods with robust accuracy for assessing VA blood flow. It is estimated that roughly 80% of VAs fail due to thrombosis. Failure to provide patients with one is a common factor leading to significant morbidity and mortality among hemodialysis (HD) patients with an estimated annual cost around 1 billion US dollars. In the following, we have attempted to review all the available trials and meta-analysis done to date to assess the true effect of VA blood flow monitoring for the purpose of early detection of thrombosis and over-minimizing the rate of intervention. A thorough and systematic search for the available literature was done on several databases such as MEDLINE, EMBASE, Cochrane library and reviewed clinical trials.gov to look for studies involving dialysis access blood flow measurement. We also reviewed the available randomized control trials and meta-analysis done on this subject so far, and the results have a variable outcome. We concluded that arteriovenous access blood flow surveillance using non-invasive ultrasound dilution and Doppler ultrasound methods in detecting stenosis may have a vital and crucial role in lowering the risk of thrombosis, promoting early management and increasing access survival.