Publication: Eficacia de las técnicas de vigilancia de segunda generación para prevenir la trombosis y aumentar la supervivencia asistida de fístulas arteriovenosas autólogas
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2021-07-19
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Universidad Complutense de Madrid
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Abstract
La causa más frecuente de pérdida del acceso vascular (AV) de hemodiálisis es la trombosis. La mayoría de las trombosis están precedidas de una estenosis. Hay diferentes métodos para detectar las estenosis y repararlas de forma precoz y todas las guías de AV recomiendan el uso de métodos de monitorización y vigilancia en las unidades de diálisis. En el caso de los métodos de segunda generación, con medida del flujo del acceso (QA) y seguimiento ecográfico periódico, existe una gran controversia sobre su rentabilidad diagnóstica. La mayoría de los estudios observacionales que analizan el efecto de la vigilancia periódica basada en la medida del QA encuentran beneficios en términos de trombosis y supervivencia asistida de las fístulas arteriovenosas, pero hay pocos ensayos clínicos aleatorizados que analicen el efecto de la vigilancia basada en la medida periódica del QA, en concreto hay 7 realizados con fístulas arteriovenosas autólogas (FAVn) y 8 con protésicas, la mayoría de ellos con pequeños tamaños muestrales y diseños y resultados heterogéneos. Los metanálisis previos al presente ensayo clínico, no encuentran evidencias claras sobre los beneficios de medir el QA e insisten en la necesidad de realizar ensayos clínicos con adecuado diseño y suficiente potencia estadística para poder sacar conclusiones definitivas...
The most frequent cause of loss of hemodialysis vascular access (VA) is thrombosis. Most thromboses are preceded by stenosis. There are different methods to detect stenosis and repair them early and all VA guidelines recommend the use of monitoring and surveillance methods in dialysis units. In the case of second generation methods, with access blood flow measurement (QA) and periodic ultrasound monitoring, there is great controversy about their diagnostic cost-effectiveness. Most of the observational studies that analyze the effect of periodic surveillance based on the measurement of QA find benefits in terms of thrombosis and assisted patency of the arteriovenous fistulas, but there are few randomized controlled trials that analyze the effect of surveillance based on the periodic measurement of QA, in particular, there are 7 carried out with native arteriovenous fistulas (AVFn) and 8 with prosthetics, most of them with small sample sizes and heterogeneous designs and results. The meta-analyses previous to the present clinical trial, do not find clear evidences about the benefits of measuring the QA and insist on the need to carry out randomized controlled trials with adequate design and enough statistical power to be able to draw definitive conclusions...
The most frequent cause of loss of hemodialysis vascular access (VA) is thrombosis. Most thromboses are preceded by stenosis. There are different methods to detect stenosis and repair them early and all VA guidelines recommend the use of monitoring and surveillance methods in dialysis units. In the case of second generation methods, with access blood flow measurement (QA) and periodic ultrasound monitoring, there is great controversy about their diagnostic cost-effectiveness. Most of the observational studies that analyze the effect of periodic surveillance based on the measurement of QA find benefits in terms of thrombosis and assisted patency of the arteriovenous fistulas, but there are few randomized controlled trials that analyze the effect of surveillance based on the periodic measurement of QA, in particular, there are 7 carried out with native arteriovenous fistulas (AVFn) and 8 with prosthetics, most of them with small sample sizes and heterogeneous designs and results. The meta-analyses previous to the present clinical trial, do not find clear evidences about the benefits of measuring the QA and insist on the need to carry out randomized controlled trials with adequate design and enough statistical power to be able to draw definitive conclusions...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 04/03/2021