Clinical Measurement of Blood Flow in Hemodialysis Access Fistulae and Grafts by Ultrasound Dilution

Depner, Thomas A.; Krivitski, Nikolai M.

doi:10.1097/00002480-199507000-00112

Cited by 95 publications

(65 citation statements)

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“…In another study, the mean OLC-Qa values obtained by Begin et al [21] were 1,285 ± 652 ml/min in chronic patients with humeral-cephalic AVF and 647 ± 331 ml/min with radiocephalic AVF. In several studies that included patients with AVG and AVF, the mean values obtained with the conductivity dialysance method were 964 ml/min [22], 950 ml/min [23], 843 ml/min [24] and 752 ml/min [25]. However, according to our results and those of other authors [20,26], the OLC-Qa method could underestimate vascular access flow with respect to the SDM.…”

Section: Discussionsupporting

confidence: 60%

Practical Utility of On-Line Clearance and Blood Temperature Monitors as Noninvasive Techniques to Measure Hemodialysis Blood Access Flow

Fontseré¹,

Blasco²,

Maduell³

et al. 2010

Blood Purif

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Background/Aims: Access blood flow (Qa) measurements are recommended by the current guidelines as one of the most important components in vascular access maintenance programs. This study evaluates the efficiency of Qa measurement with on-line conductivity (OLC-Qa) and blood temperature monitoring (BTM-Qa) in comparison with the gold standard saline dilution method (SDM-Qa). Subjects and Methods: 50 long-term hemodialysis patients (42 arteriovenous fistulas/8 arteriovenous grafts) were studied. Bland-Altman and Lin’s coefficient (ρ_c) were used to study accuracy and precision. Results: Mean values were 1,021.7 ± 502.4 ml/min SDM-Qa, 832.8 ± 574.3 ml/min OLC-Qa (p = 0.007) and 1,094.9 ± 491.9 ml/min with BTM-Qa (p = NS). Biases and ρ_c obtained were –188.8 ml/min (ρ_c 0.58) OLC-Qa and 73.2 ml/min (ρ_c 0.89) BTM-Qa. The limits of agreement (bias ± 1.96 SD) obtained were from –1,119 to 741.3 ml/min (OLC-Qa) and –350.6 to 497.2 ml/min (BTM-Qa). Conclusions: BTM-Qa and OLC-Qa are valid noninvasive and practical methods to estimate Qa, although BTM-Qa was more accurate and had better concordance than OLC-Qa compared with SDM-Qa.

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Section: Discussionsupporting

confidence: 60%

Practical Utility of On-Line Clearance and Blood Temperature Monitors as Noninvasive Techniques to Measure Hemodialysis Blood Access Flow

Fontseré¹,

Blasco²,

Maduell³

et al. 2010

Blood Purif

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“…First, limiting analyses to those patients who have had lesions corrected might influence the positive predictive value of screening studies by altering the pre-test likelihood of stenosis. Second, unlike PTFE grafts, stenosis might affect flow patterns through native vessel conduits (2,12,13), which might interfere with the transmission of a saline bolus that is necessary to perform UDT (7). Finally, the ideal frequency of screening might differ in individuals with previous stenosis, either because of more rapid progression of stenosis or recoil of the native vessels after angioplasty (14).…”

Section: Discussionmentioning

confidence: 99%

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Tonelli¹,

Hirsch²,

Clark

et al. 2002

Journal of the American Society of Nephrology

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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 ...

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“…Krivitski and colleagues [7][8][9] have developed a novel approach for assessing the access flow rate that requires reversal of the dialysis blood lines before injection of the indicator (saline). Reversal of the blood lines alters blood flow within the access and the HD circuit to facilitate the injection of the indicator in the arterial end of the access and its detection downstream.…”

Section: Saline (Ultrasound) Dilution -Reversed Dialysis Blood Linesmentioning

confidence: 99%

“…Based on studies in 25 patients, Depner and Kriviski [9] reported a mean (B SD) absolute error for duplicate measurements in close succession of the access flow rate to be 5.0 B 3.8%. Using ultrasound dilution technology, Besarab [15] has reported that 90% of all tested values were within 15% of each other (based on 4,000 measurements over 3 years); this implies a coefficient of variation (CV) of approximately 7%.…”

Section: Precisionmentioning

confidence: 99%

Standards for Reproducible Access Flow Measurements

Leypoldt

2002

Blood Purif

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Practical techniques for determining the access flow rate during hemodialysis are reviewed and compared; all are based on indicator dilution principles. The precision of duplicate determinations of the access flow rate in close succession during a given treatment session for all techniques is good; the coefficients of variation vary from 5 to 12%. Access flow measurements during an entire treatment session or from one treatment to another may be considerably more variable since changes in systemic hemodynamics can alter the access flow rate. The influence of variability in access flow measurements on tests for access surveillance is illustrated by data simulations using the Monte Carlo method. Improved approaches for normalizing access flow measurements to changing hemodynamic conditions are desirable to permit more accurate predictions of access stenosis and thrombosis.

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Clinical Measurement of Blood Flow in Hemodialysis Access Fistulae and Grafts by Ultrasound Dilution

Cited by 95 publications

References 0 publications

Practical Utility of On-Line Clearance and Blood Temperature Monitors as Noninvasive Techniques to Measure Hemodialysis Blood Access Flow

Practical Utility of On-Line Clearance and Blood Temperature Monitors as Noninvasive Techniques to Measure Hemodialysis Blood Access Flow

Access Flow Monitoring of Patients with Native Vessel Arteriovenous Fistulae and Previous Angioplasty

Standards for Reproducible Access Flow Measurements

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