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| Name | Class |
|---|---|
| CryoLife, Inc. | INDUSTRY |
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The main objective of this research study was to compare the following outcomes between patients with a Hemodialysis Reliable Outflow (HeRO) Graft and patients with a cuffed catheter for dialysis access over one year: quality of life and incidence of bacteremia, vascular interventions, hospitalizations, and death.
All eligible participants who provided informed consent were included in the study. Participants who refused HeRO Graft implantation, or did not have the HeRO Graft implanted for any other reason, were followed in the control group. Several patients did not receive the HeRO graft due to anatomical challenges and failure to complete both steps of the two-stage implant procedure. All consented participants who had an implanted HeRO Graft were followed in the study group. All participants were followed until the study end, withdrawal, loss to follow-up, or death. The analysis included only HeRO Graft patients and control patients who were not lost to follow-up; patients who were lost to follow-up, before data collection, were excluded from analysis.
After obtaining Institutional Review Board (IRB) approval, baseline demographic and clinical data was collected. Following surgery, implant procedure data was collected on study participants who received HeRO Grafts. HeRO Grafts were placed using a 2-step process with initial placement of the ePTFE portion, followed by completion of the graft by placement of the venous outflow component. Following enrollment, outcomes of interest were collected at follow-up visits scheduled weekly for 4 weeks, bi-weekly for 3 months, and monthly to 1 year, for a total of 18 follow-up visits. Study coordinators documented post-operative complications, incidence of thrombosis, hospitalizations, infection incidents, and deaths at each follow-up.
Quality of life data were also collected from all participants using the RAND Corporation's Short Form (36) (SF-36) Health Survey. This survey was completed at enrollment and again at 3 months, 6 months, and 12 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HeRO Graft | patients who are evaluated and receive a HeRO Graft implant for hemodialysis | ||
| Control | control group of non-HeRO patients who are evaluated but do not receive a HeRO Graft for any reason |
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| Measure | Description | Time Frame |
|---|---|---|
| Mortality | Compare mortality rate between study arms | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Infection Rate (Percentage of Participants With at Least One Infection) | Compare incidence of infection between study arms | 1 year |
| Quality of Life | Compare the RAND Short Form (SF)-36 Health Survey, Total Test Scores at baseline, 3, 6, and 12 months between study arms. Total test scores range on a scale from 0-100, with the lower the score equating to more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.The eight sections are: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. The total score is calculated using a methodology described by the RAND Corporation, which assigns a recoded value to each survey item. Recoded items are averaged amongst scales and the total score is an average of the eight sections. (http://www.rand.org/content/dam/rand/www/external/health/surveys\_tools/mos/mos\_core\_36item\_scoring.pdf). |
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Inclusion Criteria:
Exclusion Criteria:
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Participants with ESRD requiring permanent cuffed catheters were targeted. Participants who had not exhausted peripheral venous access sites suitable for fistulas and grafts were excluded.
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| Name | Affiliation | Role |
|---|---|---|
| Robert Provenzano, MD | St. Clair Specialty Physicians | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St. Clair Specialty Physicians | Detroit | Michigan | 48236 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18511606 | Background | Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, Canaud BJ, Pisoni RL. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008 Oct;23(10):3219-26. doi: 10.1093/ndt/gfn261. Epub 2008 May 29. | |
| 19758304 | Background |
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| ID | Title | Description |
|---|---|---|
| FG000 | HeRO Graft | patients who are evaluated and receive a Hemodialysis Reliable Outflow (HeRO) graft implant for hemodialysis |
| FG001 | Control | control group of non-HeRO patients who are evaluated but do not receive a HeRO graft for any reason |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | HeRO Graft | patients who are evaluated and receive a HeRO graft implant for hemodialysis |
| BG001 | Control | control group of non-HeRO patients who are evaluated but do not receive a HeRO graft for any reason |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Mortality | Compare mortality rate between study arms | Posted | Number | percentage of participants who died | 1 year |
|
|
1 year
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | HeRO Graft | HeRO Graft recipients |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Bleeding | Blood and lymphatic system disorders | Systematic Assessment |
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Target sample size (statistical power) was not achieved. Catheter reduction and fistula first policies limited recruitment. Additionally, study patients were not blind to exposure and this knowledge may have had an impact on QoL measurement.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Robert Provenzano | St John Hospital and Medical Center | 313-886-8787 | Rprovenzano@scsp.net |
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| ID | Term |
|---|---|
| D007676 | Kidney Failure, Chronic |
| D051437 | Renal Insufficiency |
| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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| 1 year |
| Intervention Rate (Percentage of Participants Who Required at Least One Intervention While on Study) | Compare vascular intervention rates between study arms. The vascular interventions which were included were: Angioplasty, Thrombectomy, Arteriovenous (AV) Fistulogram/Diagnostic Angiogram, Banding, Access Removal, Access Exchange, Access Revision, Creation of New Access, and any combination of these interventions which were performed simultaneously. | 1 year |
| Hospitalization Rate (Percentage of Participants Who Were Hospitalized at Least Once While on Study) | Compare incidence of hospitalization (for any reason) between study arms. Reasons for hospitalizations included: infection, cardiac problems, bleeding, vascular access thrombosis, fall (injury), hematuria, fluid overload, peripheral neuropathy, pulmonary embolism, edema, and shortness of breath. | 1 year |
| Foley RN, Chen SC, Collins AJ. Hemodialysis access at initiation in the United States, 2005 to 2007: still "catheter first". Hemodial Int. 2009 Oct;13(4):533-42. doi: 10.1111/j.1542-4758.2009.00396.x. Epub 2009 Sep 16. |
| 16449293 | Background | Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO. Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant. 2006 Apr;21(4):1024-31. doi: 10.1093/ndt/gfi104. Epub 2006 Jan 31. |
| 19628360 | Background | Katzman HE, McLafferty RB, Ross JR, Glickman MH, Peden EK, Lawson JH. Initial experience and outcome of a new hemodialysis access device for catheter-dependent patients. J Vasc Surg. 2009 Sep;50(3):600-7, 607.e1. doi: 10.1016/j.jvs.2009.04.014. Epub 2009 Jul 22. |
| 19710629 | Background | Hakim RM, Himmelfarb J. Hemodialysis access failure: a call to action--revisited. Kidney Int. 2009 Nov;76(10):1040-8. doi: 10.1038/ki.2009.318. Epub 2009 Aug 26. |
| 11786113 | Background | Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, Wolfe RA, Goodkin DA, Held PJ. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int. 2002 Jan;61(1):305-16. doi: 10.1046/j.1523-1755.2002.00117.x. |
| 1781814 | Background | Surratt RS, Picus D, Hicks ME, Darcy MD, Kleinhoffer M, Jendrisak M. The importance of preoperative evaluation of the subclavian vein in dialysis access planning. AJR Am J Roentgenol. 1991 Mar;156(3):623-5. doi: 10.2214/ajr.156.3.1781814. |
| 25907773 | Background | Bohlke M, Uliano G, Barcellos FC. Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access. 2015 Sep-Oct;16(5):347-55. doi: 10.5301/jva.5000368. Epub 2015 Apr 20. |
| 25613143 | Background | Yoon WJ, Lorelli DR. Avoiding the use of a femoral bridging catheter using a two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique. J Vasc Access. 2015 May-Jun;16(3):189-94. doi: 10.5301/jva.5000325. Epub 2015 Jan 20. |
| 1593914 | Background | Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473-83. |
| 22580402 | Background | Gage SM, Katzman HE, Ross JR, Hohmann SE, Sharpe CA, Butterly DW, Lawson JH. Multi-center experience of 164 consecutive Hemodialysis Reliable Outflow [HeRO] graft implants for hemodialysis treatment. Eur J Vasc Endovasc Surg. 2012 Jul;44(1):93-9. doi: 10.1016/j.ejvs.2012.04.011. Epub 2012 May 12. |
| 16171614 | Background | Tonnessen BH, Money SR. Embracing the fistula first national vascular access improvement initiative. J Vasc Surg. 2005 Sep;42(3):585-6. doi: 10.1016/j.jvs.2005.05.030. No abstract available. |
| 18474969 | Background | Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008 May-Jun;27(3):759-69. doi: 10.1377/hlthaff.27.3.759. |
| 22608835 | Background | Dageforde LA, Bream PR, Moore DE. Hemodialysis Reliable Outflow (HeRO) device in end-stage dialysis access: a decision analysis model. J Surg Res. 2012 Sep;177(1):165-71. doi: 10.1016/j.jss.2012.04.041. Epub 2012 May 9. |
| Background | Ware JE, Kosinski M, Gandek. SF-36 Health Survey Manual & Interpretation Guide. Lincoln RI, Quality Metric Incorporated, 2000, pp. 10-14 |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
| Secondary | Infection Rate (Percentage of Participants With at Least One Infection) | Compare incidence of infection between study arms | Posted | Number | Percentage of Patients | 1 year |
|
|
|
|
| Secondary | Quality of Life | Compare the RAND Short Form (SF)-36 Health Survey, Total Test Scores at baseline, 3, 6, and 12 months between study arms. Total test scores range on a scale from 0-100, with the lower the score equating to more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability.The eight sections are: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. The total score is calculated using a methodology described by the RAND Corporation, which assigns a recoded value to each survey item. Recoded items are averaged amongst scales and the total score is an average of the eight sections. (http://www.rand.org/content/dam/rand/www/external/health/surveys\_tools/mos/mos\_core\_36item\_scoring.pdf). | The number of completed tests varied by time point and study group. The number of completed tests for Test 1, Test 2, Test 3, and Test 4 was 14, 13, 10, and 8 for the HeRO Graft group and 17, 13, 7, and 4 for the Control group, respectively. Only completed tests were included in the analysis. | Posted | Mean | Standard Deviation | units on a scale | 1 year |
|
|
|
|
| Secondary | Intervention Rate (Percentage of Participants Who Required at Least One Intervention While on Study) | Compare vascular intervention rates between study arms. The vascular interventions which were included were: Angioplasty, Thrombectomy, Arteriovenous (AV) Fistulogram/Diagnostic Angiogram, Banding, Access Removal, Access Exchange, Access Revision, Creation of New Access, and any combination of these interventions which were performed simultaneously. | Posted | Number | percentage of participants | 1 year |
|
|
|
|
| Secondary | Hospitalization Rate (Percentage of Participants Who Were Hospitalized at Least Once While on Study) | Compare incidence of hospitalization (for any reason) between study arms. Reasons for hospitalizations included: infection, cardiac problems, bleeding, vascular access thrombosis, fall (injury), hematuria, fluid overload, peripheral neuropathy, pulmonary embolism, edema, and shortness of breath. | Posted | Number | Percentage of patients | 1 year |
|
|
|
|
| 16 |
| 16 |
| 0 |
| 16 |
| EG001 | Control | HeRO eligible patients who did not receive a HeRO Graft | 15 | 17 | 0 | 17 |
| Pulmonary Embolism | Blood and lymphatic system disorders | Systematic Assessment |
|
| Arteriosclerotic Heart Disease | Cardiac disorders | Systematic Assessment |
|
| Chest Pain | Cardiac disorders | Systematic Assessment |
|
| Congestive Heart Failure | Cardiac disorders | Systematic Assessment |
|
| Pulmonary Hypertension | Cardiac disorders | Systematic Assessment |
|
| Syncope | Cardiac disorders | Systematic Assessment |
|
| GI Bleeding | Gastrointestinal disorders | Systematic Assessment |
|
| Death-Cardiac Arrest | Cardiac disorders | Systematic Assessment |
|
| Death-Sepsis | Infections and infestations | Systematic Assessment |
|
| Death-Unknown Cause | General disorders | Systematic Assessment |
|
| Infection | Infections and infestations | Systematic Assessment |
|
| Injury-Fall | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Peripheral Neuropathy | Nervous system disorders | Systematic Assessment |
|
| Fluid Overload | Renal and urinary disorders | Systematic Assessment |
|
| Hematuria | Renal and urinary disorders | Systematic Assessment |
|
| Hemoptysis | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Shortness of Breath | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Access Creation | Vascular disorders | Systematic Assessment |
|
| Access Exchange | Vascular disorders | Systematic Assessment |
|
| Access Explant | Vascular disorders | Systematic Assessment |
|
| Access Revision | Vascular disorders | Systematic Assessment |
|
| Graft Swelling | Vascular disorders | Systematic Assessment |
|
| Intervention to Restore Patency | Vascular disorders | Systematic Assessment |
|
| Pseudoaneurysm | Vascular disorders | Systematic Assessment |
|
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| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| Test 3 (6 Months) |
|
| Test 4 (12 Months) |
|
SF-36 Test 2 Total Score |
| 2-Sided |
| Superiority or Other |
| t-test, 2 sided | 0.67 | SF-36 Test 3 Total Score | 2-Sided | Superiority or Other |
| t-test, 2 sided | <0.001 | SF-36 Test 4 Total Score | 2-Sided | Superiority or Other |