Original Investigations: Dialysis TherapiesNative arteriovenous fistula blood flow and resistance during hemodialysis
Section snippets
Study protocol
We prospectively evaluated 10 stable chronic hemodialysis patients. Nine patients usually performed their own dialysis at home. However, their dialysis was currently being performed in the hemodialysis unit at Monash Medical Centre (Melbourne, Australia) because the patients were either retraining on new dialysis machines or undergoing a routine medical assessment. All patients underwent thrice-weekly 4-hour hemodialysis treatments. Each patient was studied during three consecutive dialysis
Results
Basic demographics of study participants are listed in Table 1.
No. of patients 10 Age (y) 49 ± 13.8 No. of men 6 No. of antihypertensives prescribed (per patient) 0 7 1 1 2 2 Access type Radiocephalic fistula 5 Brachiocephalic fistula 4 Saphenous vein forearm loop 1 Predialysis BP (mm Hg) Systolic 157 ± 18.5 Diastolic 87 ± 12.3 MAP 96.9 ± 14.1 Interdialytic weight gain (kg) 1.4 ± 0.53
Discussion
The ability of Qa surveillance to predict access thrombosis will depend, in part, on hemodynamic conditions at the time of the test. Because trends in Qa are important in determining the presence of a hemodynamically significant stenosis and heightened risk for thrombosis, variability not just during a given treatment, but also from one treatment to the next is important.15
To quantify this variability, we measured Qa not just at multiple times during one treatment session, but also during three
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Cited by (24)
KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update
2020, American Journal of Kidney DiseasesCitation Excerpt :In summary, the use of surveillance methods in addition to clinical monitoring in AVF appears to increase the rate of detection of AVF stenosis and the rate of AVF intervention. Several previous studies have examined the effect of surveillance in addition to clinical monitoring in AVG.351,360,364,369 Most of the studies did not specifically examine the rate of detection of stenosis but, rather, a clinical outcome of thrombosis or patency.
Vascular Access
2005, Chronic Kidney Disease, Dialysis, & TransplantationVascular access
2004, Chronic Kidney Disease, Dialysis, & Transplantation: A Companion to Brenner & Rector's The KidneyEvaluation of fistula blood flow and resistance by regression analysis (multiple letters)
2003, American Journal of Kidney DiseasesDiagnostic accuracy of ultrasound dilution access blood flow measurement in detecting stenosis and predicting thrombosis in native forearm arteriovenous fistulae for hemodialysis
2003, American Journal of Kidney DiseasesCitation Excerpt :The pooled CV for Qa measurements and the regression equation between mean Qa values and their SDs obtained in our study indicate that assay reproducibility accounts for up to 16% of Qa measurement variability, even under standardized conditions in which hemodynamic variability is minimized. Qa variability was lower in our study than that reported for grafts,23 but similar to what others reported in AVFs,4 who found pooled CVs similar to ours for MAP (7.9% versus 8.2%), Qa (9.5% versus 7.9%), and MAP/Qa (11.9% versus 11.2% for Qa/MAP in our study) in hemodynamically stable subjects during the first hour of dialysis. Despite the relatively high variability, Qa measurement shows an excellent diagnostic performance in detecting access dysfunction; this finding is explained partially by the high prevalence of stenosis and thrombosis in our unselected forearm AVF population, a situation that usually ensures good performance, even for tests with less than ideal diagnostic accuracy.
Guidelines on vascular access for hemodialysis from the brazilian society of angiology and vascular surgery
2023, Jornal Vascular Brasileiro
Address reprint requests to Kevan R. Polkinghorne, FRACP, Department of Nephrology, Monash Medical Centre, 246 Clayton Rd, Clayton, Melbourne, Victoria 3168, Australia. E-mail: [email protected].
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