Research led by Lalathaksha Kumbar, MD of Henry Ford Health, evaluated and validated a remote access monitoring technology that can predict vascular access blockages in dialysis patients.
The single-center prospective validation study published in The vascular access journal reviewed the Vasc-Alert technology and concluded that it was a “reliable and efficient tool” for predicting which patients might need surgery for stricture or blockage in their access.
Maintaining access to functioning dialysis is critical to providing quality patient care while keeping healthcare costs low. Based on Vasc-Alert’s success in predicting access failures, as demonstrated in this validation study, this technology could play an important role in vascular access surveillance.”
Dr. Lalathaksha Kumbar, interventional nephrologist, Henry Ford Hospital, Detroit
With more than half a million Americans on dialysis, vascular access costs and complications, including access failure due to strictures, account for approximately 20 percent of hospitalizations, $2.8 billion in healthcare costs, and a substantial morbidity and mortality.
Developed by physicians at Henry Ford Hospital in 2002, Vasc-Alert is a proprietary algorithm that uses data such as arterial and venous pressures and other parameters automatically measured by dialysis machines to derive pressure within the access. Access pressure increases indicate potential complications.
The algorithm produces a vascular access risk score from 1 to 10, with a higher score corresponding to a higher likelihood of stricture that may require intervention to prevent complications.
For the study, the researchers recruited 38 patients undergoing dialysis through an arteriovenous access. Half of the patients had low-risk scores calculated by Vasc-Alert technology (a score of 1.2 or 3) and half had high-risk scores (8.9 or 10). Both groups of patients were then evaluated for access strictures using both physical and ultrasound examinations (clinical monitoring).
The results showed that patients identified as high-risk were seven times more likely to experience strictures than patients in the low-risk group, even after adjusting for other variables included in the model.
The researchers were also able to calculate how the risk increases as the score increases. If a patient’s score rises from 7 to 8, for example, the risk of stricture increases by 34%.
“By identifying high-risk patients early, we should be able to reduce thrombotic episodes by at least 30 to 40 percent,” said Dr. Kumbar. “Avoiding the need to replace a failed port can minimize the use of infection-prone catheters and save thousands of dollars per patient.”
Dr Kumbar said current surveillance methods, such as clinical monitoring and periodic blood flow measurement, are analogous to infrequently taken photographs, making it difficult to identify a problem in real time. In contrast, Vasc-Alert is more like a movie, continuously monitoring blood pressures and flows for each dialysis session and providing much more actionable information.
Additionally, Vasc-Alert can identify at-risk accesses while reducing the workload of overworked dialysis staff. Using data collected automatically during dialysis, it requires no additional time or effort from staff. In addition, the risk stratification scoring system identifies high-risk patients, which helps clinicians prioritize resources for evaluation and referral to interventions.
After more than a decade of clinical use, the Vasc-Alert database includes data from approximately 20 million individual dialysis treatments. This has led to refinements in the algorithm, increasing its accuracy in predicting login failure.
Vasc-Alert LLC was formed in 2002 to commercialize surveillance technology developed by Dr. Anatole Besarab at Henry Ford Hospital in Detroit.
Kumbar, L. et al. (2022) Association of risk stratification score with dialysis vascular access stenosis. The vascular access journal. doi.org/10.1177/11297298221136592.