TITLE: A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study.

Introduction: Arteriovenous (AV) access thrombosis remains 1 of the most troubling AV access-related complications affecting hemodialysis patients. It necessitates an urgent and occasionally complicated thrombectomy procedure and increases the risk of AV access loss. AV access stenosis is found in the majority of thrombosed AV accesses. The routine use of AV access surveillance for the early detection and management of stenosis to reduce the thrombosis rate remains controversial.

Methods: We have conducted a multicenter, prospective, randomized clinical trial comparing the standard of care coupled with ultrasound dilution technique (UDT) flow measurement monthly surveillance with the standard of care alone.

Results: We prospectively randomized 436 patients with end-stage renal disease on hemodialysis with arteriovenous fistula (AVF) or arteriovenous graft (AVG) using cluster (shift) randomization to surveillance and control groups. There were no significant differences in the baseline demographic data between the 2 groups, except for ethnicity (P = 0.017). Patients were followed on average for 15.2 months. There were significantly less per-patient thrombotic events (Poisson rate) in the surveillance group (0.12/patient) compared with the control group (0.23/patient) (P = 0.012). There was no statistically significant difference in the total number of procedures between the 2 groups, irrespective of whether thrombectomy procedures were included or excluded, and no statistically significant differences in the rate of or time to the first thrombotic event or the number of catheters placed due to thrombosis.

Conclusion: The use of UDT flow measurement monthly AV access surveillance in this multicenter randomized controlled trial reduced the per-patient thrombotic events without significantly increasing the total number of angiographic procedures. Even though there is a trend, surveillance did not reduce the first thrombotic event rate.

Source:  Salman L, Rizvi A, Contreras G, et al. A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study[J]. Kidney Int Rep, 2020, 5(11):1937-1944. DOI: 10.1016/j.ekir.2020.07.034. 

简介：动静脉（AV）通路血栓形成仍然是影响血液透析患者的最令人困扰的AV通路相关并发症之一。它需要紧急的，偶尔复杂的血栓切除术，并增加了AV通路丧失的风险。在大多数血栓性AV通路中都发现了AV通路狭窄。对于早期检测和处理狭窄以减少血栓形成率，常规使用AV通路监测仍存在争议。

方法：我们进行了一项多中心、前瞻性、随机临床试验，将标准护理联合每月监测超声稀释技术（UDT）流量测量与单独的标准护理进行了比较。

结果：我们采用聚类（转移）随机分组对436例接受透析，且行动静脉瘘（AVF）或动静脉移植物（AVG）的终末期肾脏疾病患者进行随机分组，将其随机分为监测组和对照组。除种族（P = 0.017）外，两组之间的基线人口统计学数据无显著差异。平均随访患者15.2个月。与对照组（0.23 /患者）相比，监测组（0.12 /患者）的每患者血栓形成事件（泊松分布）显著减少（P = 0.012）。两组之间的手术总数在统计学上无显著差异，而不论是否包括血栓切除术，并且首次血栓形成事件的发生率，或时间，或因血栓形成而置入的导管数目均无统计学上的显著差异。

结论：在该多中心随机对照试验中，使用每月UDT流量测量监测AV通路可减少每位患者的血栓形成事件，而不会显着增加血管造影术总数。即使有趋势，监视也不能降低首次血栓形成事件的发生率。

启发：有效的监测有利于发现早期狭窄，早期干预可减少血栓形成事件。