P1363ON-LINE SURVEILLANCE OF ESTABLISHED HAEMODIALYSIS ARTERIOVENOUS FISTULA UTILISING FRESENIUS THERAPY MONITORING SYSTEM AND EUROPEAN CLINICAL DATA SYSTEM (EUCLID): THE SHUNT STUDY- BASELINE DEMOGRAPHICS OF PARTICIPANTS
Authors: Bodington Richard , Hazara Adil , Bhandari Sunil 
Published: June 2020

Abstract

Background and Aims
The arteriovenous fistula (AVF) is well established as the preferred vascular access for haemodialysis (HD). However AVF remain prone to a number of complications, the most common of these being thrombosis, which usually occurs on the background of a developing stenosis. The development of stenosis can be detected and the lesion treated before thrombosis occurs; this forms the rationale behind monitoring and surveillance programs. Surveillance uses more resources than monitoring and has not been convincingly shown to improve outcomes such as access loss. The evidence supporting the use of the various monitoring techniques in AVF is in the main observational, under-powered, out of date and based on studies populations of predominantly arteriovenous grafts (AVG). Monitoring techniques have been shown in multiple studies to have higher utility in AVF than AVG. The modern, high efficiency dialysis machine with integrated on-line clearance monitoring (OCM) necessitates the reconsideration of the performance and utility of monitoring metrics such as Kt/V and access recirculation (AR). The lack of evidence surrounding monitoring techniques is recognised by KDOQI who recommend that further research is required to validate these indicators. In this study we aim to examine if changes in AR and Kt/V values obtained through OCM during HD can help predict AVF failure.

Method
SHUNT is a UK single-centre prospective cohort study with a 1-year follow-up of all study participants. The 100 participants are aged over 18 years receiving in-centre maintenance HD with through an established AVF. We use the Fresenius Therapy Data Monitoring System (F-TDMS) and EuCliD system to capture all dialysis treatment data from Fresenius 5008 machines. This will allow trend analysis for AR and Kt/V to assess the accuracy of these parameters in predicting access failure. The primary outcome measure is to determine whether changes in AR and Kt/V trends are able to predict AVF failure. Secondary outcome measures include assessment of the utility of AR and Kt/V alone to predict AVF failure, the comparison of AR and Kt/V trends pre- and post-intervention and the assessment of the number of patients referred for fistulograms, requiring AVF intervention and suffering access failure, VA related hospitalization and central line use.

Results
The planned 100 AVF patients have been recruited. Participants’ mean and median age is 63.07 and 63.32 years respectively with a standard deviation of 14.21. The patients are 59% male and the mean BMI is 28.27kg/m2. The mean vintage on HD is 3.41 years with a median of 2.32 years. The AVF are 37% brachiocephalic, 35% radiocephalic (65% of which are at the wrist), and 13% brachiobasilic transposition. Aetiology of primary renal disease is diabetic nephropathy in 22%, glomerulonephritis in 19%, unknown in 19%, obstructive in 15%, polycystic kidney disease in 11%, renovascular/hypertensive in 9% and assorted other pathology (eg. ATN, TIN) in 5%.

Conclusion
Our study participants are broadly representative of the UK’s AVF population as a whole. We hope that the SHUNT STUDY will provide representative, up-to-date and robust evidence for the utility of these basic monitoring tools in the prediction of AVF stenosis in the age of OCM.