To report experience over five years of vascular access (VA) stenosis surveillance.
Methods
We prospectively monitored the blood flow rate (QA) of 145 VA in 131 ESRD (age 62.6 ±13.5 y) patients (pts). QA measurement: within the first hour of the hemodialysis (HD) session by the Delta-H method using the Crit Line III Monitor. All VA with baseline QA < 700 mL/min or decreased > 20% from baseline over time met the positive evaluation (PE) criteria and were referred for angiography (AG) plus elective intervention if stenosis ≥ 50%.
Results
We found 54 cases of PE in 47 VA; the AG was performed in 87% (47/54) cases of PE and most of them (43/47, positive predictive value: 91.5%) showed significant stenosis (mean degree 80.5 ±12.9%). Mean QA increased from 554.7±107.6 mL/min to 977.9 ± 359.9 mL/min just before versus after preventive intervention (P<.001). Without difference when comparing the highest QA reported before stenosis development (889.8 ± 409.5 mL/min) and the QA recorded just post-intervention (P=.18). Kt/V index: improved from 1.43 ± 0.22 to 1.49 ± 0.21 just before versus after intervention (P=.006).
Conclusions
1) The Delta-H technique is an accurate method for early diagnosis of VA stenosis and is useful in monitoring the hemodynamic effect of elective VA treatment. 2) After preventive intervention for stenosis, functional VA status is restored and HD delivery is improved.
National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access.Am J Kidney Dis.2006; 48(Suppl 1): S1–S322.
2.
TordoirJ., CanaudB., HaageP.. European best practice guidelines (EBPG) on Vascular Access.Nephrol Dial Transplant.2007; 22(Suppl 2): ii88–ii117.
3.
Roca-TeyR., SamonR., IbrikO.. Vascular access surveillance with blood flow monitoring: A prospective study with 65 patients.Nefrologia2004; 24: 246–252.
4.
Roca-TeyR., SamonR., IbrikO., Martínez-CercósR., ViladomsJ.Functional vascular access evaluation after elective intervention for stenosis.J Vasc Access2006; 7: 29–34.
5.
YararD., CheungA.K., SakiewiczP.. Ultrafiltration method for measuring vascular access flow rates during hemodialysis.Kidney Int.1999; 56: 1129–1135.
6.
Roca, TeyR.Early diagnosis of hemodialysis vascular access stenosis using the non-invasive determination of blood flow. Doctoral thesis, Universitat Autònoma de Barcelona, 2010. http://hdl.handle.net/10803/32023
7.
TonelliM., JindalK., HirschD., TaylorS., KaneC., HenbreyS.Screening for subclinical stenosis in native vessel arteriovenous fistulae.J Am Soc Nephrol.2001; 12: 1729–1733.
8.
TessitoreN., BedognaV., GammaroL.. Diagnostic accuracy of ultrasound dilution access blood flow measurement in detecting stenosis and predicting thrombosis in native forearm arteriovenous fistulae for hemodialysis.Am J Kidney Dis.2003; 42: 331–341.
9.
SantosC., OliveiraC., CarvalhoD., Loureiro-SantosJ.P., RamosA., PonceP.Prospective monitoring of AV graft blood flow with hematocrit dilution technique for venous stenosis detection.Blood Purif.2003; 21: 449 (Abstract).
10.
LarsonK., HaglundL., CarsonR.Use of Crit-Line Delta-H access blood flow in a vascular access management program to decrease episodes of thrombosis and increase URR.Hemodial Int.2004; 8: 81 (Abstract).
11.
TessitoreN., BedognaV., PoliA.. Adding access blood flow surveillance to clinical monitoring reduces thrombosis rates and costs, and improves fistula patency in the short term: a controlled cohort study.Nephrol Dial Transplant.2008; 23: 3578–3584.
12.
CamposR.P., do NascimentoM.M., ChulaD.C., do NascimentoD.E., RiellaM.C.Stenosis in hemodialysis arteriovenous fistula: evaluation and treatment.Hemodial Int.2006; 10: 152–161.
13.
DuijmL.E.M., OverboschE.H., LiemY.S.. Retrograde catheterization of haemodialysis fistulae and grafts: angiographic depiction of the entire vascular access tree and stenosis treatment.Nephrol Dial Transplant.2009; 24: 539–547.
14.
DoelmanC., DuijmL.E.M., LiemY.S.. Stenosis detection in failing hemodialysis access fistulas and grafts: comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance angiography, and digital subtraction angiography.J Vasc Surg.2005; 42: 739–746.
15.
Turmel-RodriguesL., PengloanJ., BaudinS.. Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology.Nephrol Dial Transplant.2000; 15: 2029–2036.
16.
AsifA., GadaleanF.N., MerrillD.. Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study.Kidney Int.2005; 67: 1986–1992.
17.
Roca-TeyR., IbrikO., SamonR., Martínez-CercósR., ViladomsJ.Prevalence and functional profile of unsuspected radial artery (RA) stenosis in native radiocephalic fistula (RCF) dysfunction. Diagnosis by vascular access (VA) flow (QA) monitoring using the Delta-h method.Nefrologia2006; 26: 581–586.
18.
SmitsJ.H.M., Van der LindenJ., HagenE.C.. Graft surveillance: venous pressure, access flow, or the combination?Kidney Int.2001; 59: 1551–1558.
19.
AsifA., BesarabA., GadaleanF.. Utility of static pressure ratio recording during angioplasty of arteriovenous graft stenosis.Semin Dial.2006; 19: 551–557.
20.
Monroy-CuadrosM., SalazarA., YilmazS., McLaughlinK.Native arteriovenous fistulas: correlation of intra-access blood flow with characteristics of stenoses found during diagnostic angiography.Semin Dial.2008; 21: 89–92.
21.
AsifA., LenzO., MerrillD.. Percutaneous management of perianastomotic stenosis in arterovenous fistulae: results of a prospective study.Kidney Int.2006; 69: 1904–1909.
22.
LipariG., TessitoreN., PoiA.. Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for hemodialysis.Nephrol Dial Transplant.2007; 22: 2605–2612.
23.
Van der LindenJ., SmitsJ.H.M., AssinkJ.A.. Short- and long- term functional effects of percutaneous transluminal angioplasty in hemodialysis vascular access.J Am Soc Nephrol.2002; 13: 715–720.
24.
TessitoreN., MansuetoG., LipariG.. Endovascular versus surgical preemptive repair of forearm arteriovenous fistula juxta-anastomotic stenosis: analysis of data collected prospectively from 1999 to 2004.Clin J Am Soc Nephrol.2006; 1: 448–454.
25.
BacchiniG., CappelloA., La MiliaV., AndrulliS., LocatelliF.Color Doppler ultrasonography imaging to guide transluminal angioplasty of venous stenosis.Kidney Int.2000; 58: 1810–1813.
26.
AhyaS.N., WindusD.W., VeselyT.M.Flow in hemodialysis grafts after angioplasty: do radiologic criteria predict success?Kidney Int.2001; 59: 1974–1978.
27.
WindusD.W., AudrainJ., VandersonR., JendrisakM.D., PicusD., DelmezJ.A.Optimization of high-efficiency hemodialysis by detection and correction of fistula dysfunction.Kidney Int.1990; 38: 337–341.
28.
Pérez-MartínezJ., LlamasF., López-RubioE., Gómez-RoldánC.Percutaneous angioplasty evaluation in vascular access for hemodialysis: effect on hemodynamic parameters and the dialysis adequacy.Nefrologia2005; 25: 445–446.
29.
HakimR.M., BreyerJ., IsmailN., SchulmanG.Effects of Dose of Dialysis on Morbidity and Mortality.Am J Kidney Dis.1994; 23: 661–669.
30.
HeldP.J., PortF.K., WolfeR.A.. The dose of hemodialysis and patient mortality.Kidney Int.1996; 50: 550–556.
