Thermodilution versus Saline Dilution Method for Vascular Access Blood Flow Measurement in High-Flux and On-Line Hemodiafiltration

Fontseré, Néstor; Maduell, Francisco; Blasco, Miquel; Vera, Manel; Arias, Marta; Mestres, Gaspar; Bermúdez, Patricia; Campistol, Josep M.

doi:10.5301/jva.5000091

Cited by 4 publications

(1 citation statement)

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“…This indirect dilution method detects early fistula dysfunction by the percentage of access recirculation with a diagnostic sensitivity of 81.8% and a specificity of 98.6% [27]. In our previous cross-sectional studies, we concluded that this method offered a good estimation compared with Qa measured with the gold standard Transonic® method in validation conditions, using a high-flux technique with Qb 300 ml/min without OL-HDF [6,28]. For this reason, it is very important not to consider the Kt value obtained during the day of BTM-Qa measurement because it could lead to false-positive conclusions on access function.…”

Section: Discussionmentioning

confidence: 99%

Observational Study of Surveillance Based on the Combination of Online Dialysance and Thermodilution Methods in Hemodialysis Patients with Arteriovenous Fistulas

Fontseré

Mestres²,

Burrel

et al. 2014

Blood Purif

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Background/Aims: Online dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs. This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group. Methods: We studied 148 hemodialysis patients with arteriovenous fistulas (control group, n = 74) for 2 years. During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa <500 ml/min (or a decrease in flow >20%). Results: During the study period, we detected 16 cases of vascular dysfunction. The Kt value after vascular treatment was 71.1 liters (59 liters; p = 0.001) and BTM-Qa was 1,218.6 ml/min (519.7 ml/min; p = 0.001). Compared with the control group, the thrombosis rate was 0.027 versus 0.148 episodes/patient-year (p = 0.009) and the total access-related cost was EUR 22,293 versus 47,467 (p = 0.033). Conclusions: This study suggests that a combined monitoring program based on Kt and BTM-Qa represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments.

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Section: Discussionmentioning

confidence: 99%

Observational Study of Surveillance Based on the Combination of Online Dialysance and Thermodilution Methods in Hemodialysis Patients with Arteriovenous Fistulas

Fontseré

Mestres²,

Burrel

et al. 2014

Blood Purif

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Guía Clínica Española del Acceso Vascular para Hemodiálisis

et al. 2017

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Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare.

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