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• W4231138763 abstract "We thank Drs Tuka and Malik for their letter.1Tuka V. Malik J. Vascular access surveillance: no benefit.Am J Kidney Dis. 2008; 52 (letter): 628Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar As stated in our article, we agree that the current literature has limitations. In our previous reports, we have been strong advocates for vascular access screening. However, with the availability of additional data, we realized that the data are inconclusive about whether screening patients with fistulas is beneficial (and suggest no benefit for patients with grafts).As we acknowledge, one cannot exclude the possibility that screening patients with fistulas is beneficial, although it seems unlikely that screening will be helpful for those with grafts. However, our article clearly shows that the benefits of screening are uncertain at best. Review of existing practice guidelines indicates that current recommendations for routine screening are based largely on observational data. Pending new evidence, clinicians and policy makers would probably be unwise to adopt screening in jurisdictions in which it is not currently offered.Therefore, is it really too early to stop screening? To some extent, this depends on one's willingness to spend money on diagnostic tests that may (or may not) benefit patients, but will certainly inconvenience them and lead to substantial costs. In patients with grafts, the failure of screening to improve patency in randomized trials seems much more persuasive than the observational data that suggest benefit. For us, this is enough to recommend against routine screening of patients with grafts. Regarding patients with fistulas, we believe that the guidelines should be revised to reflect the current uncertainty, but we recognize that others may disagree.Finally, as stated in our article, we agree with Drs Tuka and Malik that additional randomized trials are required in this important area. We thank Drs Tuka and Malik for their letter.1Tuka V. Malik J. Vascular access surveillance: no benefit.Am J Kidney Dis. 2008; 52 (letter): 628Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar As stated in our article, we agree that the current literature has limitations. In our previous reports, we have been strong advocates for vascular access screening. However, with the availability of additional data, we realized that the data are inconclusive about whether screening patients with fistulas is beneficial (and suggest no benefit for patients with grafts). As we acknowledge, one cannot exclude the possibility that screening patients with fistulas is beneficial, although it seems unlikely that screening will be helpful for those with grafts. However, our article clearly shows that the benefits of screening are uncertain at best. Review of existing practice guidelines indicates that current recommendations for routine screening are based largely on observational data. Pending new evidence, clinicians and policy makers would probably be unwise to adopt screening in jurisdictions in which it is not currently offered. Therefore, is it really too early to stop screening? To some extent, this depends on one's willingness to spend money on diagnostic tests that may (or may not) benefit patients, but will certainly inconvenience them and lead to substantial costs. In patients with grafts, the failure of screening to improve patency in randomized trials seems much more persuasive than the observational data that suggest benefit. For us, this is enough to recommend against routine screening of patients with grafts. Regarding patients with fistulas, we believe that the guidelines should be revised to reflect the current uncertainty, but we recognize that others may disagree. Finally, as stated in our article, we agree with Drs Tuka and Malik that additional randomized trials are required in this important area. Support: None. Financial Disclosure: None. Vascular Access Surveillance: No Benefit?American Journal of Kidney DiseasesVol. 52Issue 3PreviewA recent meta-analysis of vascular access surveillance1 showed little or no profit of stenosis surveillance programs (ultrasound and access flow). However: Full-Text PDF" @default.
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• W4231138763 date "2008-09-01" @default.
• W4231138763 modified "2023-09-26" @default.
• W4231138763 title "In Reply" @default.
• W4231138763 doi "https://doi.org/10.1053/j.ajkd.2008.06.010" @default.
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