#2768 Evaluation of vascular access via a TRIAGE system for hemodialysis: a tool to assess clinical risk in hemodialysis patients
Authors: Rotondi Silverio , Tartaglione Lida , Pasquali Marzia , Romano Carmine , Erbaggio Gioacchino , Santoro Gianluca , Scarpati Luisa , Satta Ersilia , Mazzaferro Sandro 
Published: May 2024

Abstract

Background and Aims
The type and efficacy of vascular access (VA) in hemodialysis (HD) play pivotal roles in determining the quality of treatment and, eventually, the clinical outcome of patients. Low dialysis quality due to suboptimal vascular access functioning is a risk factor for increased cardiovascular mortality in HD. In a prior study involving 754 patients undergoing chronic HD, we demonstrated that a VA TRIAGE system effectively identified vascular accesses at a higher risk of complications both in patients with arteriovenous fistula (AVF) and in patients with central venous catheters (CVC). The TRIAGE categorization is generated monthly through a scoring system recording several parameters of each session, like blood flow, VA pressure, end HD circuit clots, external VA examination, and KT/V. Based on threshold values, VA performance is classified as Green (G), Yellow (Y), or Red).
In this study, we aimed to assess whether the TRIAGE system, by identifying poorly functioning VA, could also identify patients at a higher risk of cardiovascular events.

Method
In this interventional prospective, blinded multicentre study, each centre utilized the VA TRIAGE electronic spreadsheet without knowledge of the generated triage. After six months of system implementation, a two-year follow-up (01/01/2020 - 01/12/2021) was conducted to record cardiovascular events (myocardial infarction, cerebrovascular accident, peripheral vasculopathy, unstable angina, atrial fibrillation, heart failure). External reviewers assessed the records, and a minimum of three months of VA follow-up was necessary for patient enrolment.

Results
From 18 HD centres, 757 patients were enrolled, with an average age of 64.5 ± 15.5 years; 27% were diabetics, undergoing HD for 24.4 ± 32.4 months; 369 (48.7%) had AVF, and 388 (51.3%) had a permanent CVC. Over 11.4±5.6 months of follow-up (range 3-23) and 108, 537 HD sessions recorded in the TRIAGE system, 100 cardiovascular-related events occurred during 16.3 ± 2.2 months of follow-up (range 3-23). The VA TRIAGE was: 60% Green, 35% Yellow, and 5% Red. The Green Triage group demonstrated a lower incidence of cardiovascular events independent of VA type (25% vs. 75%; P: 0.01) and a higher duration free from cardiovascular events (AVF Green vs. AVF Yellow-Red: log-rank test: 0.04).

Conclusion
Our VA TRIAGE system not only identifies poorly functioning vascular accesses but also effectively assesses the clinical risk in patients undergoing HD. This outcome, in our view, is linked to the diminished quality of dialysis resulting from lower VA function in the yellow and red Triage groups compared to the green Triage group. Integrating the VA TRIAGE system with additional clinical parameters enhances its capacity to assess the clinical risk of HD patients. This approach offers a more comprehensive evaluation, potentially improving the identification of patients at higher cardiovascular risk.