TRIAGE-AV

The TRIAGE-AV project consists of the validation of a clinical decision-support system based on a predictive algorithm generated by the systematic monitoring of vascular access in haemodialysis patients.
The system involves the structured collection, at each dialysis session, of clinical, haemodynamic and biochemical parameters, recorded by medical and nursing staff on a dedicated form.
By means of an average monthly score, each vascular access is classified into three risk categories — Green, Yellow and Red — enabling consistent communication among operators and the timely identification of dysfunction.
The multicentre, prospective study involved 28 dialysis centres and analysed more than 108,500 haemodialysis sessions, with the scientific support of the Department of Translational and Precision Medicine of the Sapienza University of Rome, which oversaw the statistical planning and the evaluation of the collected data.

The primary objective of the project is to assess the difference in hard outcomes — such as deaths, hospital admissions and their duration — between patients undergoing TRIAGE-AV monitoring and patients on standard treatment without such a system.
Secondary objectives include: verifying whether adoption of the system leads to an improvement in vascular-access risk classification and in the clinical parameters related to dialysis therapy; assessing whether implementation corresponds to improved vascular-access performance and longevity over time; and analysing separately, for arteriovenous fistulae (AVF) and central venous catheters (CVC), the association between triage classes and significant clinical events.
The ultimate objective is to optimise haemodialysis therapy through a predictive system capable of alerting the clinician promptly, prompting the most appropriate therapeutic choices and reducing morbidity, mortality, hospitalisations and healthcare costs, with a positive impact on patients' quality of life.
In 2023 the TRIAGE-AV system demonstrated full applicability on a large scale, with 108,537 haemodialysis sessions recorded for 757 patients from 28 centres.
The system identified 40% of vascular accesses as at risk (yellow/red triage), compared with the 11% detected using the routine tools of the individual centres, demonstrating a markedly superior capacity to recognise early dysfunction.
In patients with AVF, 57% of subjects with yellow–red triage developed an access-related event, compared with 32% of subjects with green triage (p<0.05); similar results were observed in patients with central venous catheters (CVCs).
The most relevant finding is that the system identifies vascular-access dysfunction on average 300 days before the clinical event develops.
The analysis also extended the predictive validity to major cardiovascular events (stroke, myocardial infarction, thromboembolism), with a significantly more favourable Hazard Ratio in patients classified as green triage, confirming the usefulness of the system as a tool for cardiovascular risk stratification in patients on chronic haemodialysis.