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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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

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          Abstract

          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<sub>c</sub>) 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<sub>c</sub> obtained were –188.8 ml/min (ρ<sub>c</sub> 0.58) OLC-Qa and 73.2 ml/min (ρ<sub>c</sub> 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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          Vascular access use in Europe and the United States: results from the DOPPS.

          Ronald L. Pisoni, Erwin Hecking, Jock W. Young … (2001)
          A direct broad-based comparison of vascular access use and survival in Europe (EUR) and the United States (US) has not been performed previously. Case series reports suggest that vascular access practices differ substantially in the US and EUR. We report on a representative study (DOPPS) which has used the same data collection protocol for> 6400 hemodialysis (HD) patients to compare vascular access use at 145 US dialysis units and 101 units in five EUR countries (France, Germany, Italy, Spain, and the United Kingdom). Logistic analysis evaluated factors associated with native arteriovenous fistula (AVF) versus graft use or permanent access versus catheter use for prevalent and incident HD patients. Times to failure for AVF and graft were analyzed using Cox proportional hazards regression. AVF was used by 80% of EUR and 24% of US prevalent patients, and was significantly associated with younger age, male gender, lower body mass index, non-diabetic status, lack of peripheral vascular disease, and no angina. After adjusting for these factors, AVF versus graft use was still much higher in EUR than US (AOR=21, P 30 days prior to ESRD compared with 74% in the US (P < 0.0001); pre-ESRD care was associated with increased odds of AVF versus graft use (AOR=1.9, P=0.01). New HD patients had a 1.8-fold greater odds (P=0.002) of starting HD with a permanent access if a facility's typical time from referral to access placement was < or =2 weeks. AVF use when compared to grafts was substantially lower (AOR=0.61, P=0.04) when surgery trainees assisted or performed access placements. When used as a patient's first access, AVF survival was superior to grafts regarding time to first failure (RR=0.53, P=0.0002), and AVF survival was longer in EUR compared with the US (RR=0.49, P=0.0005). AVF and grafts each displayed better survival if used when initiating HD compared with being used after patients began dialysis with a catheter. Large differences in vascular access use exist between EUR and the US, even after adjustment for patient characteristics. The results strongly suggest that a facility's preferences and approaches to vascular access practice are major determinants of vascular access use.
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            Theory and validation of access flow measurement by dilution technique during hemodialysis.

            Nikolai M Krivitski (1995)
            The theory shows that access flow can be measured by the dilution technique by reversal of the blood dialysis lines with the venous outlet facing the access stream: (1.) with one dilution sensor in arterial line and two injections Equation (6); (2.) with two matched dilution sensors on the venous line and on the arterial line and one injection Equation (8); (3.) with blood sampling as for recirculation measurement using BUN or other methods in Equation (12). In all cases, accurate measurement of hemodialysis blood flow is required. The results of this bench validation demonstrate that dialysis blood flows, in the clinical range of 200 to 350 ml/min or more, create good mixing conditions in a vascular access model. Accurate measurements are provided for all clinically significant ranges of access flows, needle positions, and vascular access inner diameters. This simple, non-invasive, and inexpensive technique shows great promise for routine diagnosis of vascular access failure in hemodialysis patients.
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              Colour Doppler ultrasound in dialysis access.

              P Wiese, B. Daniel (2004)
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                Author and article information

                Journal
                Journal ID (publisher-id): BPU
                Journal ID (nlm-ta): Blood Purif
                Journal ID (doi): 10.1159/issn.0253-5068
                Title: Blood Purification
                Publisher: S. Karger AG
                ISSN (Print): 0253-5068
                ISSN (Electronic): 1421-9735
                Publication date Subscription-year: 2011
                Publication date (Print): January 2011
                Publication date (Electronic): 07 December 2010
                Volume: 31
                Issue: 1-3
                Pages: 1-8
                Affiliations
                Departments of aNephrology, bInterventional Vascular Radiology, and cVascular Surgery, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
                Author notes
                *Néstor Fontseré Baldellou, Department of Nephrology, Hospital Clínic de Barcelona, C/Villarroel No. 170, ES–08036 Barcelona (Spain), E-Mail fontsere@clinic.ub.es
                Article
                Publisher ID: 321364 Other ID: Blood Purif 2011;31:1–8
                DOI: 10.1159/000321364
                PubMed ID: 21135543
                SO-VID: 79f0f3de-13b9-4247-b9e3-1787c2dbf050
                Copyright © © 2010 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 21 May 2010
                Date accepted : 15 September 2010
                Page count
                Figures: 3, Tables: 1, Pages: 8
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Access flow,Vascular access,On-line clearance monitoring,Saline dilution method,Hemodialysis,Blood temperature monitoring
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Access flow, Vascular access, On-line clearance monitoring, Saline dilution method, Hemodialysis, Blood temperature monitoring

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