Prospective Evaluation of Remote Software Based Surveillance Supplementing Clinical Monitoring For Hemodialysis Vascular Access.

Abstract

Background and hypothesis: Efficient arteriovenous access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units.

Methods: We conducted a 12-month prospective study on maintenance hemodialysis (HD) patients using Vasc-Alert software technology to assist clinical decision-making in 2 satellite HD units (Group 1) and standard care in the remaining 3 HD units (Group 2) . Patients with Vasc-alert derived high Access Risk Score (ARS) (≥7) underwent clinical assessment and were referred for fistulogram based on relevant Kidney Disease Outcome Quality Initiative (KDOQI) criteria. Data on referrals for fistulogram, subsequent VA events, access abandonment, and complication-free days- extended (CFD-extended) were collected.. VA survival analysis of post-intervention primary patency rate at 3 and 6 months was conducted.

Results: There were 23 (28.1%) preemptive correction of stenosis and 6 (7.3%) thrombosis episodes in Group 1, compared to 40 (19.5%)and 21 (10.2%) in Group 2 (p value 0.155, 0.587),respectively). Amongst the thrombotic episodes, 83% of cases in Group 1 had been detected during surveillance and referred for diagnostic fistulogram +/- angioplasty but developed thrombosis whilst awaiting elective intervention compared to 19% in Group 2 (P value = 0.004). Median time from fistulogram request to thrombosed VA was 26 days (IQR 21-42 days).Group 1 exhibited better post-intervention primary patency rates and longer CFD compared to Group 2 (p value < 0.001, 0.002, respectively).

Conclusion: Incorporating Vasc-Alert technology into VA clinical surveillance pathway was associated with improved early detection of high-risk VA, higher primary patency rates, and longer CFD-extended compared to standard of care. Improving elective interventional radiology (IR) capacity for timely intervention (< 3 weeks from referral) is crucial to materialise the benefits of enhanced surveillance in preventing acute thrombosis.