The Transonic team spoke with professor Ferruh Artunc on the abstract he presented at Kidney Week 2016. Artunc’s abstract is the first study to show a prognostic significance of measuring hemodynamic parameters in HD patients. See what he had to say about it as well as the high cardiovascular death rates among hemodialysis patients below.
Clinicians from the Hospital Infanta Sofía, Madrid, Spain, undertook a three-year follow-up multicenter, prospective, open-label, controlled RCT to determine the impact of access blood flow surveillance in AV fistulas.
The group acknowledged at the outset that surveillance remains controversial because randomized RCTs failed to consistently demonstrate the benefits of flow-based surveillance even though vascular access clinical guidelines recommend monitoring and surveillance protocols to prevent vascular access thrombosis.
Pediatric nephrologists at Boston's prestigious Children's Hospital recognized that an arteriovenous (AV) access is the preferred vascular access for dialysis delivery in children and adolescents requiring chronic hemodialysis (HD). They also understood that, because of the small size of the accesses, maintenance of an access after it is created becomes all the more important and difficult.
Ultrasound dilution (UD) monitoring of AV access flow is widely used in adult HD units for early stenosis detection, but its experience in pediatrics is limited. Therefore, the Boston group they undertook a study to examine its usefulness in children and adolescents.
Carlo Basile and colleagues from hospitals in Manduria, Italy, were among the first to recognize the relationship between vascular access flow of arteriovenous fistulas (AVFs) and cardiac output (CO). In 2008 they conducted a study to glean better insight into this rarely explored aspect of HD pathophysiology.
Jennifer MacRae and her colleagues from the University of Calgary, Calgary, Alberta, Canada, reviewed the hemodynamic and cardiovascular consequences of arteriovenous fistulas. Their findings were published in a 2006 paper in Seminars in Dialysis.
MacRae identified three periods when the presence of an AV fistula influences a patient's hemodynamics.
Lower Mortality and Dialysis Patients
Researchers found a fistula attempt could be a “surrogate marker for a healthy patient who has had good care prior to starting dialysis,” while catheters were preferred for patients who had a short life expectancy, an acute kidney injury or poor blood vessels.
The researchers also discovered that excess mortality rates in dialysis patients with catheters do not appear to be due to access-related complications but rather the result of “residual confounding, unmeasured comorbidity, or treatment selection bias.”
Frenovia Renal Research will be opening an office in Durham, North Carolina. The company is a subsidiary of Fresenius Medical Care North America and will also expand staff at its locations in New York, Illinois, Florida and Louisiana in addition to North Carolina.