It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study

Sun, Chien-Wen; Mo, Yuchang; Lan, Lijuan; Han, Xiaowei; Song, Li; Zhang, Guan-Rong; Zhou, Lifang; Zheng, Shuqian; Chen, Ying-Gui; Liu, Shuangxin; Liang, Xinling; Fu, Xinping

doi:10.1177/1129729820917266

Cited by 2 publications

(4 citation statements)

References 26 publications

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“…Chan et al performed an observational matched cohort analysis among 40,132 Medicare beneficiaries receiving hemodialysis with a fistula or graft. 21 PTA was found to be frequent at a rate of 20.9 procedures per 100 access years. Angiography and PTA significantly increased access survival when compared with nonintervention.…”

Section: Discussionmentioning

confidence: 97%

“…Excessive negative PPAP can lead to a decrease in the delivery of blood flow, inadequate dialysis, and hemolysis and in most settings is restricted to a value of −250 mm Hg. Unfortunately, these recommendations are often disregarded in clinical practice with pressure sensors being “removed” from the dialysis circuit 21 . The absolute PPAP to blood pump speed (Qb) ratio which we term AAPR may reflect dysfunction of the vascular access.…”

Section: Discussionmentioning

confidence: 99%

“…Referring hemodialysis patients for elective access angiography and percutaneous transluminal angioplasty (PTA) is commonly done to prevent access failure. Chan et al performed an observational matched cohort analysis among 40,132 Medicare beneficiaries receiving hemodialysis with a fistula or graft 21 . PTA was found to be frequent at a rate of 20.9 procedures per 100 access years.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, these recommendations are often disregarded in clinical practice with pressure sensors being “removed” from the dialysis circuit. 21 The absolute PPAP to blood pump speed (Qb) ratio which we term AAPR may reflect dysfunction of the vascular access. In a retrospective analysis, of 490 hemodialysis patients with an AVF, this parameter alone had a sensitivity and specificity of 61% and 73% respectively using a cut off value of 0.5 in predicting AVF dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a risk score to prioritize patients for evaluation of access stenosis

Astor

Hirschman²,

Kennedy³

et al. 2021

Seminars in Dialysis

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Background: Access flow dysfunction, often associated with stenosis, is a common problem in hemodialysis access and may result in progression to thrombosis. Timely identification of accesses in need of evaluation is critical to preserving a functioning access. We hypothesized that a risk score using measurements obtained from the Vasc-Alert surveillance device could be used to predict subsequent interventions. Methods: Measurement of five factors over the preceding 28 days from 1.46 million hemodialysis treatments (6163 patients) were used to develop a score associated with interventions over the subsequent 60 days. The score was validated in a separate dataset of 298,620 treatments (2641 patients). Results: Interventions in arteriovenous fistulae (AVF; n = 4125) were much more common in those with the highest score (36.2%) than in those with the lowest score (11.0). The score also was strongly associated with interventions in patients with an arteriovenous graft (AVG; n = 2,038; 43.2% vs. 21.1%). There was excellent agreement in the Validation datasets for AVF (OR = 2.67 comparing the highest to lowest score) and good agreement for AVG (OR = 1.92).Conclusions: This simple risk score based on surveillance data may be useful for prioritizing patients for physical examination and potentially early referral for intervention. | INTRODUCTIONMaintaining a functioning arteriovenous (AV) access is critical to providing adequate dialysis clearance, reducing catheter exposure, and lowering the costs of care in patients on chronic hemodialysis. Indeed, vascular accesses (VAs) are considered to be the "Achilles' heel" of hemodialysis. 1 Vascular access-related expenses and complications account for approximately 20% of hospitalizations, $2.8 billion in healthcare costs in the US, and substantial morbidity and mortality. 2 As surgical procedures and hospitalizations associated with attempts to maintain a functioning AV access are major contributors to these costs, 3 methods to avoid these adverse outcomes are needed.Inadequate access blood flow is a common problem in mature AV fistulas (AVF) and grafts (AVG), resulting in inefficient dialysis and an inability to attain prescribed Kt/V as an indicator of adequate dialysis. 4 Hemodynamically significant stenoses may occur in the inflow, main body, or outflow of the vascular access, reducing blood flow in the access. Stenosis can occur at a single site or develop at multiple sites; these may develop concurrently or more commonly sequentially.Stenosis invariably leads to access dysfunction. Inadequate access flow most often is associated with one or more underlying stenoses, 5

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Development and validation of a risk score to prioritize patients for evaluation of access stenosis

Astor

Hirschman²,

Kennedy³

et al. 2021

Seminars in Dialysis

View full text Add to dashboard Cite

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Intradialytic techniques for automatic and everyday access monitoring

Schneditz

Ribitsch

Keane

2023

Seminars in Dialysis

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Vascular access dysfunction is associated with reduced delivery of dialysis, unplanned admissions, patient symptoms, and loss of access, making assessment of vascular access a fundamental part of routine care in dialysis. Clinical trials to predict the risk of access thrombosis based on accepted reference methods of access performance have been disappointing. Reference methods are time‐consuming, affect the delivery of dialysis, and therefore cannot repeatedly be used with every dialysis session. There is now a new focus on data continuously and regularly collected with every dialysis treatment, directly or indirectly associated with access function, and without interrupting or affecting the delivered dose of dialysis. This narrative review will focus on techniques that can be used continuously or intermittently during dialysis, taking advantage of methods integrated into the dialysis machine and which do not affect the delivery of dialysis. Examples include extracorporeal blood flow, dynamic line pressures, effective clearance, dose of delivered dialysis, and recirculation which are all routinely measured on most modern dialysis machines. Integrated information collected throughout every dialysis session and analyzed by expert systems and machine learning has the potential to improve the identification of accesses at risk of thrombosis.

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It is time to implement prepump arterial pressure monitoring during hemodialysis: A retrospective multicenter study

Cited by 2 publications

References 26 publications

Development and validation of a risk score to prioritize patients for evaluation of access stenosis

Development and validation of a risk score to prioritize patients for evaluation of access stenosis

Intradialytic techniques for automatic and everyday access monitoring

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