Study Design: Prediction of Vascular Access Steal Syndrome, in Hemodialysis Patients, Using Digital Pressure Measurements

Abstract

Research Question: In hemodialysis patients with arteriovenous fistula, can a digital pressure measurement done prior to fistula placement positively predict the development of vascular access steal syndrome after fistula placement?

Background, Significance, and Rationale for the Question: In 2017, End Stage Renal Disease (ESRD) affected 746,557 people in the United States, with 86.9% beginning renal replacement therapy through hemodialysis (HD). This requires an access for dialysis, through arteriovenous (AV) fistula. There are numerous complications associated with hemodialysis access. The most extreme is ischemic loss to limbs. Currently, there is no literature on a measurement that could be used to predict the occurrence of ischemia, as vascular access steal syndrome, prior to placement of an AV fistula. Digital pressure, a measurement of blood flow, was identified by Schanzer as a tool to diagnosis ischemia in AV fistula patients. This retrospective study aims to use digital pressure data measurement to identify a threshold value of digital pressure prior to fistula placement that will predict ischemia after hemodialysis access placement and use.

Materials and Methods: A retrospective study will be performed. Patients seen at DFW Vascular Group and University Vascular Associates will be identified for the study. Patients will be identified as having had an AV fistula placement between the years of 2010 and 2020. Data collection from medical records will include digital pressure measurement before AV fistula placement and at all subsequent visits throughout hemodialysis treatment. Additional variables, such as sex, age, and the presence of pertinent comorbidities, will also be collected as secondary factors to identify possible confounding variables and for use in future research. In addition, the development of limb ischemia/vascular access steal syndrome will also be identified. Statistical analysis will be performed using a logistic regression to identify the probability of vascular access steal syndrome development for a given digital pressure value.

Anticipated Results, Conclusions, and Impact: We anticipate that individuals with a lower digital pressure prior to AV Fistula placement are more likely to development vascular access steal syndrome. We expect to find a threshold value that will give practitioners a digital pressure measurement that can be used as an alert. After identification of these high-risk patients, clinicians can manage care more appropriately, using pharmacological treatments or closer monitoring, to prevent or prolong the onset of ischemia. This may be helpful in preventing life-altering amputations or decreases in hand/arm function. It may also reduce healthcare costs for the patient and system.