Department of Medicine, Division of Nephrology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Vasc-Alert, LLC, Lafayette, Indiana, USA.
Semin Dial. 2022 May;35(3):236-244. doi: 10.1111/sdi.13026. Epub 2021 Oct 12.
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.
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).
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).
This simple risk score based on surveillance data may be useful for prioritizing patients for physical examination and potentially early referral for intervention.
血流功能障碍，常与狭窄有关，是血液透析通路的常见问题，并可能导致血栓形成。及时发现需要评估的通路对于维持功能良好的通路至关重要。我们假设，使用 Vasc-Alert 监测设备获得的测量值计算得出的风险评分可用于预测随后的干预。
在 146 万例血液透析治疗（6163 例患者）中，在过去 28 天内测量了五个因素，以制定与随后 60 天内干预相关的评分。在 298620 例治疗（2641 例患者）的独立数据集上对该评分进行了验证。
动静脉瘘（AVF；n=4125）的干预措施在评分最高的患者（36.2%）中比评分最低的患者（11.0%）更为常见。该评分与动静脉移植物（AVG；n=2038；43.2%与 21.1%）的干预措施也有很强的相关性。在验证数据集中，AVF 的评分具有极好的一致性（OR=2.67，比较最高与最低评分），而对于 AVG 则具有良好的一致性（OR=1.92）。
这种基于监测数据的简单风险评分可能有助于为患者进行体格检查和潜在的早期干预提供优先级排序。
