A study led by Henry Ford Health’s Lalathaksha Kumbar, MD, evaluated and validated remote sensing technology that can predict coronary artery occlusion in dialysis patients.
The single-center prospective confirmation study published in Journal of Vascular Access reviewed the Vasc-Alert technology and concluded that it is a “reliable and useful tool” for predicting which patients will need intervention for stenosis, or blockage, in their access.
Maintaining the availability of dialysis is critical to providing quality patient care and keeping healthcare costs low. Based on Vasc-Alert’s success in predicting vascular failures, as demonstrated in a validation study, this technology may play an important role in vascular monitoring. “
Dr. Lalathaksha Kumbar, interventional nephrologist, Henry Ford Hospital, Detroit
With more than half a million Americans on dialysis, costs related to vascular access and complications – including access failure due to stenosis – account for nearly 20% of hospitalizations, $2.8 billion in medical costs and morbidity and mortality.
Developed by physicians at the Henry Ford Hospital in 2002, Vasc-Alert is a reliable system that uses data such as blood pressure and other factors measured by the dialysis machine to find the pressure within the opportunity. An increase in access power indicates potential problems.
The algorithm creates a risk of the arteries from 1 to 10, with a higher number corresponding to an increase in the risk of stenosis that may require intervention to prevent complications.
In this study, researchers enrolled 38 patients receiving dialysis through arteriovenous access. Half of the patients had low risk factors calculated by the Vasc-Alert technology (a score of 1,2 or 3) and half had high risk factors (8,9 or 10). All groups of patients were evaluated for stenosis by physical and ultrasound examinations (clinical evaluation).
The results showed that patients classified as high risk were seven times more likely to have stenosis than patients in the low risk group, even after adjusting for other factors included in the model.
The researchers were also able to calculate how the risk increased as the number increased. For example, if the patient’s risk increases from 7 to 8, the risk of stenosis increases by 34 percent.
“By identifying patients at high risk in advance, we should reduce thrombotic episodes by 30 to 40 percent,” said Dr. Kumbar. “Avoiding the need for access to failed catheters can reduce the use of potentially infected catheters and save thousands of dollars per patient.”
Dr. Kumbar said that modern methods of diagnosis, such as clinical examination and periodic blood tests, are similar to photographs that are taken often, which makes it difficult to diagnose the problem in real time. In contrast, the Vasc-Alert is like a moving image, continuously monitoring pressure and blood flow during each dialysis session and providing actionable information.
In addition, Vasc-Alert can identify those at risk while reducing the burden on overworked staff. By using the information collected automatically during dialysis, it does not require the effort of the staff or time. Additionally, a clinical stratification scoring system identifies high-risk patients, which helps clinicians prioritize screening and referrals for treatment.
After more than a decade of clinical use, the Vasc-Alert database includes information from nearly 20 million dialysis treatments. This has led to refinements of the algorithm, increasing its accuracy in predicting failure to find.
Vasc-Alert LLC was founded in 2002 to sell the monitoring technology developed by Dr. He collected Besarab from Henry Ford Hospital in Detroit.
Kumbar, L., and al. (2022) Association of risk stratification score with dialysis vascular access stenosis. Journal of Vascular Access. doi.org/10.1177/11297298221136592.