Did stopping ultrasound surveillance during COVID-19 result in an increase of the dialysis access thrombosis rate?

Allsopp, Karen; Smith, Lindsay

Abstract

Purpose: The COVID-19 pandemic resulted in cessation and subsequent reduction of routine care including the outpatient ultrasound surveillance of AVF. This un-planned service disruption allowed evaluation of effectiveness of US surveillance in reducing AVF/AVG thrombosis. Methods: This study was a secondary data analysis of monthly access patency for all in-centre patients receiving haemodialysis using an AVF or AVG over a 2-year period (April 2019-March 2021). The study included 298 patients with age, access type, patency and COVID status measured as variables. Thrombosis rates for the 12 months prior to COVID-19 and then during the first 12 months of the pandemic were also measured. Statistical analysis to assess mean and standard deviation for relevant variables was used. A p-value of <0.05 was deemed significant. Results: At the end of the study an increase in thrombosis rate (%) in the non-surveillance year was observed ((1.20) thrombosis/patient/year in the surveillance group vs (1.68) thrombosis/patient/year in the non-surveillance group). Monthly mean of thrombosed access during surveillance (M = 3.58, 95% CI 2.19–4.98, SD = 2.193) and non-surveillance (M = 4.92, 95% CI 3.52–6.31, SD = 2.19); t(7148) = 2.051, p = 0.038. Conclusion: Reduction in routine Ultrasound surveillance following the COVID-19 pandemic was associated with a significant increase in access thrombosis rate. Further research is needed to unpick whether the associations seen were directly due to service changes, associated with COVID-19 or other factors during the pandemic. This association was independent of SARS-CoV-2 infection status. Clinical teams should consider alternative service delivery options including out-reach, bedside surveillance to balance risks of access thrombosis versus reducing the risk of nosocomial infection with hospital visits.

• Journal Article Type: Article
• Acceptance Date: May 19, 2023
• Online Publication Date: Jun 9, 2023
• Publication Date: Sep 30, 2024
• Deposit Date: May 23, 2023
• Publicly Available Date: Jul 10, 2023
• Journal: Journal of Vascular Access
• Electronic ISSN: 1724-6032
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 5
• Pages: 1539 - 1543
• DOI: https://doi.org/10.1177/11297298231180326
• Keywords: arteriovenous fistula, Access, ultrasound, surveillance, COVID-19, burden, thrombosis
• Public URL: https://uwe-repository.worktribe.com/output/10811760
• Publisher URL: https://journals.sagepub.com/doi/abs/10.1177/11297298231180326