Validation of a novel ultrasound Doppler monitoring device (earlybird) for measurements of volume flow rate in arteriovenous fistulas for hemodialysis

Abstract

Background:

Controversy exists regarding surveillance of arteriovenous fistulas for hemodialysis to increase patency. A significant reduction in volume flow rate (VFR) should lead to diagnostic evaluation and eventually intervention. Several methods are available for VFR measurements, but all of them are associated with low reproducibility. VFR trend analysis is suggested as an improved solution. It is therefore a need to find user-friendly, cost and time-effective modalities. We present a novel Doppler ultrasound device (earlybird) which could bridge this gap. It includes an easy-to-use and light-weight single element transducer.

Methods:

In an experimental and clinical setting, we compared earlybird to duplex ultrasound to assess VFR. In a closed circuit of blood-mimicking fluid, 36 paired calculations of calibrated, duplex ultrasound and earlybird VFR was measured. In addition, 23 paired recordings of duplex ultrasound and earlybird VFR was measured in 16 patients with underarm arteriovenous fistulas. Pearson correlation, intraclass correlation coefficient, root-mean-square and Bland-Altman plots were analyzed.

Results:

Strong correlation (r = 0.991, p < 0.001), and excellent level of agreement (ICC = 0.970 (95% CI 0.932 - 0.985), p < 0.001) between earlybird and the calibrated VFR was found in the experimental setup. This was confirmed in the clinical setting, with a strong correlation (r = 0.781, p < 0.001) and moderate to good level of agreement (ICC = 0.750 (95% CI 0.502–0.885), p < 0.001) between earlybird and duplex ultrasound VFR measured at the arteriovenous fistulas outflow veins. In the Bland-Altman plot-analysis for the experimental setup, we found smaller limits of agreement, a smaller consistent and proportional bias, as well as greater accuracy of earlybird than DUS when compared to the calibrated VFR.

Conclusion:

Earlybird is a feasible tool for VFR measurements and could be a future promising device for easy assessment and surveillance of AVF for hemodialysis.

Keywords

Ultrasonography Doppler duplex volume flow rate arteriovenous fistula hemodialysis renal failure inventions earlybird

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References

Gallieni

Hollenbeck

Inston

, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34: ii1–ii42.

Malik

Lomonte

Meola

, et al. The role of Doppler ultrasonography in vascular access surveillance-controversies continue. J Vasc Access 2021; 0: 1129729820928174.

Schmidli

Widmer

Basile

, et al. Editor’s choice - vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 757–818.

Tordoir

Canaud

Haage

, et al. EBPG on vascular access. Nephrol Dial Transplant 2007; 22(Suppl. 2): ii88–ii117.

Ibeas

Roca-Tey

Vallespín

, et al. Spanish clinical guidelines on vascular access for haemodialysis. Nefrologia 2017; 37(Suppl. 1): 1–191.

Kumwenda

Mitra

Reid

. Clinical Practice Guideline – Vascular Access for Haemodialysis. 6th ed., https://ukkidney.org/sites/renal.org/files/vascular-access.pdf (Accessed on November 18th, 2021) (2015).

Hwang

Lee

, et al. Comparison of ultrasound scan blood flow measurement versus other forms of surveillance in the thrombosis rate of hemodialysis access: a systemic review and meta-analysis. Medicine 2018; 97: e11194.

Etkin

Talathi

Rao

, et al. The role of Duplex ultrasound in assessing AVF maturation. Ann Vasc Surg 2021; 72: 315–320.

Valliant

McComb

. Vascular access monitoring and surveillance: an update. Adv Chronic Kidney Dis 2015; 22: 446–452.

10.

Muchayi

Salman

Tamariz

, et al. A meta-analysis of randomized clinical trials assessing hemodialysis access thrombosis based on access flow monitoring: where do we stand? Semin Dial 2015; 28: E23–E29.

11.

Nickinson

Rogers

Elbasty

, et al. Outcomes of post-operative duplex ultrasound following arteriovenous fistula formation: a pragmatic single-centre experience. J Vasc Access 2020; 21: 623–629.

12.

Lok

Huber

Lee

, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 2020; 75: S1–s164.

13.

Zamboli

Fiorini

D'Amelio

, et al. Color doppler ultrasound and arteriovenous fistulas for hemodialysis. J Ultrasound 2014; 17: 253–263.

14.

Bandyk

. Interpretation of duplex ultrasound dialysis access testing. Semin Vasc Surg 2013; 26: 120–126.

15.

Lomonte

Meola

Petrucci

, et al. The key role of color Doppler ultrasound in the work-up of hemodialysis vascular access. Semin Dial 2015; 28: 211–215.

16.

Pettersen

Avdal

Hisdal

, et al. Validation of a novel ultrasound Doppler monitoring device (earlybird) for detection of microvascular circulatory changes. Clin Hemorheol Microcirc 2020; 74: 429–440.

17.

Bolstad

Hoff

Torp

, et al. Design, fabrication and testing highly sensitive single element Doppler transducers. In: 2018 IEEE international ultrasonics symposium (IUS), Kobe, Japan, 22–25 October 2018, pp.1–4. New York: IEEE.

18.

van Stralen

Jager

Zoccali

, et al. Agreement between methods. Kidney Int 2008; 74: 1116–1120.

19.

Watson

Petrie

. Method agreement analysis: a review of correct methodology. Theriogenology 2010; 73: 1167–1179.

20.

Koo

. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155–163.

21.

Bland

Altman

. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135–160.

22.

Krouwer

. Why Bland-Altman plots should use X, not (Y+X)/2 when X is a reference method. Stat Med 2008; 27: 778–780.

23.

Zierler

Leotta

Sansom

, et al. Analysis of factors influencing accuracy of volume flow measurement in dialysis access fistulas based on Duplex ultrasound simulation. Vasc Endovascular Surg 2019; 53: 529–535.

24.

Shiu

Pike

, et al. Comparison of hemodialysis arteriovenous fistula blood flow rates measured by Doppler ultrasound and phase-contrast magnetic resonance imaging. J Vasc Surg 2018; 68: 1848–1857.e2.

25.

Heerwagen

Hansen

Schroeder

, et al. Blood flow measurements during hemodialysis vascular access interventions–catheter-based thermodilution or Doppler ultrasound? J Vasc Access 2012; 13: 145–151.

26.

Karava

Kwon

Franco

, et al. Ultrasound dilution and thermodilution versus color Doppler ultrasound for arteriovenous fistula assessment in children on hemodialysis. Pediatr Nephrol 2019; 34: 2381–2387.

27.

Sun

Song

, et al. How to carry out monthly blood flow surveillance of fistula in large-scale hemodialysis units: a cross-sectional study. J Vasc Access 2021; 22: 75–80.

28.

Rittgers

Garcia-Valdez

McCormick

, et al. Noninvasive blood flow measurement in expanded polytetrafluoroethylene grafts for hemodialysis access. J Vasc Surg 1986; 3: 635–642.

29.

Bouthier

Levenson

Simon

, et al. A noninvasive determination of fistula blood flow in dialysis patients. Artif Organs 1983; 7: 404–409.

30.

Thomas

Lewis

Hill

, et al. Technical recommendations for the use of carotid duplex ultrasound for the assessment of extracranial blood flow. Am J Physiol Regul Integr Comp Physiol 2015; 309: R707–R720.

31.

Hudson

Williams

Milot

, et al. In vivo validation of volume flow measurements of pulsatile flow using a clinical ultrasound system and matrix array transducer. Ultrasound Med Biol 2017; 43: 579–585.

32.

Meola

Ibeas

Lasalle

, et al. Basics for performing a high-quality color Doppler sonography of the vascular access. J Vasc Access 2021; 2021: 11297298211018060.

33.

Van Canneyt

Swillens

Lovstakken

, et al. The accuracy of ultrasound volume flow measurements in the complex flow setting of a forearm vascular access. J Vasc Access 2013; 14: 281–290.

34.

Nalesso

Garzotto

Petrucci

, et al. Standardized protocol for hemodialysis vascular access assessment: the role of ultrasound and colorDoppler. Blood Purif 2018; 45: 260–269.

35.

Bandyk

Hodgkiss-Harlow

, et al. Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation. J Vasc Surg 2015; 61: 1521–1527.

36.

Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48(Suppl. 1): S176–S247.

37.

Guidi

Licciardello

Falteri

. Intrinsic spectral broadening (ISB) in ultrasound Doppler as a combination of transit time and local geometrical broadening. Ultrasound Med Biol 2000; 26: 853–862.

38.

Gill

. Pulsed Doppler with B-mode imaging for quantitative blood flow measurement. Ultrasound Med Biol 1979; 5: 223–235.

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