Jochen Raimann, MD, PhD, a master’s student at the CUNY Graduate School of Public Health and Health Policy and manager of data analytics at the Renal Research Institute, along with CUNY SPH faculty Dr. Levi Waldron, and additional colleagues, examined a previously published meta-analysis on the success rate of procedures dealing with complications related to hemodialysis in patients with Chronic Kidney Disease (CKD).
For maintenance hemodialysis over protracted periods of time permanent arteriovenous accesses to the circulatory system are required. The most commonly used access is the arteriovenous fistula which is a direct surgically created connection between an artery and a vein, followed in prevalence by the arteriovenous graft which is a connection of an artery and a vein with prosthetic material (either synthetic or autologous). Unfortunately, both fistulas and grafts are often presenting with complications differing in nature and timing in reference to its creation, both aspects notably characteristically differing between accesses. “For this very reason it was surprising to us that a recent meta-analysis had pooled both and investigated, based on data from 10 prospective trials, the effect of preemptive surgical access correction (surgical intervention upon first sign of complication) compared to deferred care (standard of care with intervention only when some predefined criteria are met or hemodialysis is no longer feasible with the access) on the relative risk of losing the access altogether (requiring the creation of an entirely new access). Even more surprising the authors reported no significant differences between both approaches,” explains Dr. Raimann.
Dr. Raimann and colleagues revisited the data extraction of the Ravani et al. paper and amended an obvious error that affected the significance of the overall model and also conducted Monte Carlo simulation studies to outline the effect of heterogeneity on the overall results of this study. They found that there was a non-significant protective benefit of 13% conferred by preemptive correction on loss of arteriovenous grafts and a remarkable beneficial effect on arteriovenous fistulas (halving the risk of loss compared to standard of care).
Raimann, J., Waldron, L., Koh, E., Miller, G., Sor, M., Gray, R. and Kotanko, P. (2017). Meta-analysis and commentary: Preemptive correction of arteriovenous access stenosis. Hemodialysis International.