Abstract. Screening strategies based on measurement of access blood flow (Qa) allow detection and angioplasty of subclinical stenosis in native vessel arteriovenous (AV) fistulae. However, little is known about the efficacy of Qa measurements for detecting recurrent stenoses in fistulae and that of angioplasty for correcting them. A total of 303 patients were studied over 30 mo; 69 (23%) of these had stenoses, of whom 53 underwent angioplasty. Of those undergoing angioplasty, 30 patients had 46 episodes of recurrent positive studies and underwent repeat fistulography. In 31 of these episodes (19 patients), stenosis was again identified and treated successfully with angioplasty. Overall positive predictive values for stenosis were similar in first and subsequent episodes of stenosis (71% versus 67%), and angioplasty was associated with sustained increases in Qa for both first and subsequent episodes. Assisted patency in fistulae that required repeat angioplasty was 87% (median follow-up 10 mo after the second angioplasty). In conclusion, Qa is effective for detecting first and subsequent lesions in patients with AV fistulae, and angioplasty of first or subsequent lesions is associated with sustained increments in Qa. Continued screening after correction of first stenoses appears reasonable, because of both the frequency of recurrent stenosis and the success of repeat intervention.Ultrasound dilution measurement of access blood flow (Qa) has been shown to accurately identify first episodes of subclinical stenosis in native vessel fistulae (1). Most such stenoses, once identified, are amenable to percutaneous angioplasty, which is associated with short-term improvements in Qa and dialysis delivery. Although access screening programs have been shown to prolong the use-life of polytetrafluoroethylene (PTFE) grafts (2) and cohorts of mixed access type (3), little data exists on the effect of such programs on native arteriovenous dialysis fistulae (4 -6).The diagnostic performance of Qa in native vessel fistulae that have previously undergone angioplasty for stenosis is unknown. The positive predictive value of screening might differ substantially in this population compared with unselected fistulae, both because of the prevalence of stenosis and because of mechanical effects of angioplasty on the native vessel conduit. Finally, the effectiveness of angioplasty for correcting recurrent stenoses in fistulae is unclear. These data will become increasingly relevant as access screening programs are implemented in more dialysis centers and the prevalence of fistulae with previously angioplastied stenosis increases.There were two objectives for the current study. The first was to determine the positive predictive value of ultrasound dilution techniques (UDT) for the detection of subclinical stenoses in fistulae that have previously undergone angioplasty. The second was to document the efficacy of angioplasty at correcting stenoses in fistulae that have previously undergone angioplasty. In both cases, results from those with ...

Abstract. Canadian clinical practice guidelines recommend performing angiography when access blood flow (Qa) is Ͻ500 ml/min in native vessel arteriovenous fistulae (AVF), but data on the value of Qa that best predicts stenosis are sparse. Because correction of stenosis in AVF improves patency rates, this issue seems worthy of investigation. Receiver-operating characteristic curves were constructed to examine the relation-

Our findings suggest that a single Qa threshold for angiography in all patients may be simplistic, and that the optimal threshold might vary by patient subgroup. The strong association between SBP and Qa suggests that adjusting Qa for SBP may improve the specificity of access screening. Further work is required to determine whether such modifications to current practice would improve the predictive power of Qa measurements for detection of stenosis in AVF.

BackgroundIt has been shown that in-center hemodialysis (HD) nurses prefer in-center HD for patients with certain characteristics; however it is not known if their opinions can be changed.ObjectiveTo determine if an education initiative modified the perceptions of in-center HD nurses towards home dialysis.DesignCross-sectional survey of in-center HD nurses before and after a three hour continuing nursing education (CNE) initiative. Content of the CNE initiative included a didactic review of benefits of home dialysis, common misconceptions about patient eligibility, cost comparisons of different modalities and a home dialysis patient testimonial video.SettingAll in-center HD nurses (including those working in satellite dialysis units) affiliated with a single academic institutionMeasurementsSurvey themes included perceived barriers to home dialysis, preferred modality (home versus in-center HD), ideal modality distribution in the local program, awareness of home dialysis and patient education about home modalities.MethodsPaired comparisons of responses before and after the CNE initiative.ResultsOf the 115 in-center HD nurses, 100 registered for the CNE initiative and 89 completed pre and post surveys (89% response rate). At baseline, in-center HD nurses perceived that impaired cognition, poor motor strength and poor visual acuity were barriers to peritoneal dialysis and home HD. In-center HD was preferred for availability of multidisciplinary care and medical personnel in case of catastrophic events. After the initiative, perceptions were more in favor of home dialysis for all patient characteristics, and most patient/system factors. Home dialysis was perceived to be underutilized both at baseline and after the initiative. Finally, in-center HD nurses were more aware of home dialysis, felt better informed about its benefits and were more comfortable teaching in-center HD patients about home modalities after the CNE session.LimitationsSingle-center studyConclusionsCNE initiatives can modify the opinions of in-center HD nurses towards home modalities and should complement the multitude of strategies aimed at promoting home dialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-015-0051-z) contains supplementary material, which is available to authorized users.