Preemptive Correction of Arteriovenous Access Stenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Pietro RavaniGiovanni F M Strippoli

Abstract

Preemptive correction of a stenosis in an arteriovenous (AV) access (fistula or graft) that is adequately providing hemodialysis (functional AV access) may prolong access survival as compared to waiting for signs of access dysfunction to intervene (deferred salvage). However, the evidence in support of preemptive intervention is controversial. We evaluated benefits and harms of preemptive versus deferred correction of AV access stenosis. Systematic review and meta-analysis of randomized controlled trials. Adults receiving hemodialysis by a functional AV access. We searched the Cochrane Kidney and Transplant Specialised Register and EMBASE to October 15, 2015. Active access surveillance (flow measurement and Doppler or venous pressure) and preemptive correction of a newly identified stenosis versus routine clinical monitoring and deferred salvage, or preemptive correction of a known stenosis versus deferred salvage. Access loss (primary outcome) and thrombosis (overall and by access type), infection, mortality, hospitalization, and access-related procedures. We included 14 trials (1,390 participants; follow-up, 6-38 months). Relative to deferred salvage, preemptive correction of AV access stenosis had a nonsignificant effect on ...Continue Reading

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Citations

Mar 11, 2017·Techniques in Vascular and Interventional Radiology·Keith B QuencerThomas Kinney
Apr 18, 2017·The Korean Journal of Internal Medicine·Seong ChoSung-Rok Kim
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