Vascular access monitoring improves outcomes

Vascular access monitoring can identify patients at increased risk of future access thrombosis. When coupled with a program of elective stenosis correction, access thrombosis rates decline approximately 50-75%. This results in arteriovenous (AV) fistula thrombosis rates of 0.1-0.2/patient year (vs. 0.2-0.4 at baseline) and AV graft thrombosis rates <0.5/patient year (vs. 0.8-1.2 thromboses/patient year at baseline). Evaluating the long-term impact on access survival remains problematic. There are no large-scale randomized trials and existing studies exhibit marked differences in target populations, clinical protocols and outcome definitions. Differences in payment systems also significantly influence the efficacy of monitoring and intervention programs. Despite these challenges, the current data support the K/DOQI recommendations that all patients undergo a program of regular access monitoring preferably by access flow measurement coupled with prompt imaging and elective stenosis correction for low flow accesses.