| Does monthly native arteriovenous fistula blood-flow surveillance detect significant stenosis--a randomized controlled trial. | |
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MedLine Citation:
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PMID: 16854848 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Clinical practice guidelines recommend that the preferred method of surveillance for arteriovenous fistula (AVF) is the measurement of AVF blood flow (Qa). As these recommendations are based on observational studies, we conducted a randomized, prospective, double-blind, controlled trial to assess whether Qa surveillance results in an increased detection of AVF stenosis. METHODS: A total of 137 patients were randomly assigned to receive either continuing AVF surveillance using current clinical criteria (control, usual treatment) or usual treatment plus AVF blood-flow surveillance by ultrasound dilution (Qa surveillance group). The primary outcome measure was the detection of a significant (>50%) AVF stenosis. RESULTS: There were 67 and 68 patients assigned to the control and Qa surveillance groups, respectively. Patients in the Qa surveillance group were twice as likely to have a stenosis detected compared with the control hazard ratio (HR) confidence interval (CI) group (2.27, 95% 0.85-5.98, P = 0.09), with a trend for a significant stenosis to be detected earlier in the Qa surveillance group (P = 0.09, log rank test). However, using the Qa results alone prior to angiography, the area under the receiver operating characteristic curve demonstrated, at best, a moderate prediction of (>50%) AVF stenosis (0.78, 95% CI 0.63-0.94, P = 0.006). CONCLUSION: This study demonstrates that the addition of AVF Qa monitoring to clinical screening for AVF stenosis resulted in a non-significant doubling in the detection of angiographically significant AVF stenosis. Further, large multi-centre randomized trials are feasible and will be necessary to confirm whether Qa surveillance and the correction of detected AVF stenosis will lead to a reduction in AVF thrombosis and increased AVF survival. |
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Authors:
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Kevan R Polkinghorne; Kenneth K P Lau; Alan Saunder; Robert C Atkins; Peter G Kerr |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2006-07-19 |
Journal Detail:
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Title: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Volume: 21 ISSN: 0931-0509 ISO Abbreviation: Nephrol. Dial. Transplant. Publication Date: 2006 Sep |
Date Detail:
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Created Date: 2006-08-24 Completed Date: 2006-10-12 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8706402 Medline TA: Nephrol Dial Transplant Country: England |
Other Details:
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Languages: eng Pagination: 2498-506 Citation Subset: IM |
Affiliation:
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Department of Nephrology, Monash Medical Centre, 246 Clayton Rd, Clayton, Melbourne, Victoria 3168, Australia. kevan.polkinghorne@med.monash.edu.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angiography, Digital Subtraction Arteriovenous Shunt, Surgical* Blood Flow Velocity / physiology* Double-Blind Method Female Follow-Up Studies Graft Occlusion, Vascular / physiopathology, radiography, ultrasonography* Humans Kidney Failure, Chronic / radiography, therapy*, ultrasonography Male Middle Aged Prognosis Prospective Studies Renal Dialysis / methods* Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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