| Risk of hemodialysis graft thrombosis: analysis of monthly flow surveillance. | |
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MedLine Citation:
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PMID: 18845369 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: During clinical application of flow surveillance of hemodialysis grafts, the risk of thrombosis is assessed month after month, rather than after one or several measurements, as has been done in published studies. Adequate assessment of risk should consider the many measurements obtained over time. STUDY DESIGN: Prospective cohort diagnostic test study. SETTING & PARTICIPANTS: 176 patients with hemodialysis grafts from 2 university-affiliated dialysis units during a 6-year period. INDEX TESTS: Monthly measurement of graft blood flow or change in flow. OUTCOME: Graft thrombosis. RESULTS: We used logistic regression analysis to compute the risk of thrombosis and used receiver operating characteristic (ROC) curves to assess the accuracy in predicting thrombosis within 1 month. Newer grafts were most likely to thrombose, whereas older grafts were unlikely to thrombose even at low flows or large decreases in flow. Areas under the ROC curves were 0.698 for flow and 0.713 for change in flow measured over 2 months. Flow predicted thrombosis with a sensitivity of 53% at a specificity of 79%, and change in flow had a sensitivity of 58% at a specificity of 75%. More than half the thromboses lacked a change in flow measurement, usually because thrombosis occurred before a change could be measured. Thus, the effective predictive accuracy of change in flow was much less than the ROC curves indicated because the curves do not consider missing measurements. LIMITATIONS: Performance characteristics of index tests may vary across patient populations. CONCLUSION: Flow and change in flow are inaccurate predictors of thrombosis. Many thromboses are not predicted, and intervention based on surveillance likely yields many unnecessary procedures. Thus, this study does not support routine application of surveillance to prevent thrombosis. |
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Authors:
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Sunanda J Ram; Raja Nassar; Jack Work; Kenneth Abreo; Neville R Dossabhoy; William D Paulson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-10-08 |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 52 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-10-30 Completed Date: 2008-11-13 Revised Date: 2011-08-25 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 930-8 Citation Subset: IM |
Affiliation:
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Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Vessel Prosthesis* Female Humans Male Middle Aged Postoperative Complications / epidemiology* Prospective Studies Regional Blood Flow Renal Dialysis* Risk Assessment Thrombosis / epidemiology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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