Development and validation of a risk score to prioritize patients for evaluation of access stenosis
Recommended Citation
Astor BC, Hirschman K, Kennedy J, Frinak S, and Besarab A. Development and validation of a risk score to prioritize patients for evaluation of access stenosis. Semin Dial 2021.
Document Type
Article
Publication Date
10-12-2021
Publication Title
Seminars in dialysis
Abstract
BACKGROUND: 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.
METHODS: 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).
RESULTS: 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).
CONCLUSIONS: This simple risk score based on surveillance data may be useful for prioritizing patients for physical examination and potentially early referral for intervention.
PubMed ID
34642963
ePublication
ePub ahead of print
