Research led by Henry Ford Health’s Lalathaksha Kumbar, MD, evaluated and validated a remote access monitoring technology that can predict vascular access obstruction in dialysis patients.
A single center prospective validation study published in Journal of Vascular Access reviewed the Vasc-Alert technique and concluded that it is a “reliable and valid tool” for predicting which patients may require intervention to resolve narrowing or blockages in the pathway.
Maintaining functional dialysis access is critical to providing quality patient care while keeping healthcare costs low. Based on the success of Vasc-Alert in predicting access failure, as demonstrated in this validation study, this technology could play an important role in vascular access monitoring. “
Dr. Lalathaksha Kumbar, Interventional Nephrologist, Henry Ford Hospital, Detroit
More than half a million Americans receive dialysis, and costs and complications associated with vascular access—including access failure due to stenosis—account for approximately 20 percent of hospitalizations, $2.8 billion in healthcare costs, and substantial morbidity and death Rate.
Developed by clinicians at Henry Ford Hospital in 2002, Vasc-Alert is a proprietary algorithm that uses data such as arterial and venous pressures, as well as other parameters automatically measured by the dialysis machine, to derive the pressure within the access. An increase in access pressure indicates a potential complication.
The algorithm produces a vascular access risk score of 1 to 10, with higher scores corresponding to an increased likelihood of stenosis that may require intervention to prevent complications.
For the study, the researchers recruited 38 patients receiving dialysis through an arteriovenous access. Half of the patients had a low risk score (score of 1, 2 or 3) and half of the patients had a high risk score (8, 9 or 10) calculated by the Vasc-Alert technique. Patients in both groups were then assessed for access stenosis by physical examination and ultrasonography (clinical monitoring).
The results showed that patients identified as high-risk were seven times more likely to develop stenosis than those in the low-risk group, even after adjusting for other variables included in the model.
The researchers were also able to calculate how risk increased as the score increased. For example, if a patient’s score rose from 7 to 8, the risk of stenosis increased by 34%.
“By identifying high-risk patients early, we should be able to reduce thrombotic events by at least 30 to 40 percent,” Dr. Kumbar said. “Avoiding the need to replace a failed access can minimize the use of infection-prone catheters and save thousands of dollars per patient.”
Dr. Kumbar said current monitoring methods, such as clinical monitoring and regular measurement of blood flow, resemble still photos that are taken infrequently, making real-time identification of the problem challenging. In contrast, Vasc-Alert is more like a movie, continuously monitoring pressure and blood flow during each dialysis session, and providing more actionable information.
Additionally, Vasc-Alert can identify at-risk passages while relieving the burden on overworked dialysis staff. By using data collected automatically during dialysis, no additional staff effort or time is required. In addition, a risk-stratification scoring system identifies high-risk patients, which helps clinicians prioritize resources for evaluation and referral for intervention.
With more than a decade of clinical use, the Vasc-Alert database contains data from approximately 20 million individual dialysis treatments. This has led to improved algorithms that increase the accuracy of predicting access failures.
Vasc-Alert LLC was formed in 2002 to commercialize monitoring technology developed by Dr. Anatole Besarab of Detroit’s Henry Ford Hospital.
Kumbar, L., Wait. (2022) Association of risk stratification scores with dialysis vascular access stenosis. Journal of Vascular Access. doi.org/10.1177/11297298221136592.