Comparison of Different Methods to Assess Fistula Flow

Eloot, Sunny; Dhondt, Annemieke; Hoeben, Heidi; Vanholder, Raymond

doi:10.1159/000318586

Cited by 9 publications

(12 citation statements)

References 36 publications

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“…It is of interest that a previous study which compared OCMT with UDT in HD mode showed that OCMT was unreliable since the clearances in the reversed position were almost equal to or even higher than those obtained in the normal position [14]. This was completely in contrast with the results of the present study.…”

Section: Discussioncontrasting

confidence: 99%

“…The latter actual clearance values were utilized for calculating Qa in the present study. However, there were no details available regarding which clearance values were used in the previous study [14]. …”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, the ionic dialysance from OCM could also be used for accurate Qa measurement in other Fresenius HD and HDF machines without such a specific module. However, a recent study using OCM for Qa measurement in HD reported unreliable results [14]. This would raise the question about the validity of using OCM for Qa determination.…”

Section: Introductionmentioning

confidence: 99%

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Measurement of Vascular Access Flow by Online Clearance Monitor in Online Hemodiafiltration

Tiranathanagul

Susantitaphong²,

Towannang³

et al. 2011

Blood Purif

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Background: Measurement of ionic dialysance has been shown to accurately determine urea dialyzer clearance and vascular access flow rate (Qa) in diffusive hemodialysis. Recently, online clearance monitoring (OCM) in an online hemodiafiltration (OL-HDF) machine could accurately measure urea dialyzer clearance. In the present study, OCM was utilized to assess the Qa in OL-HDF. Methods: In 32 stable end-stage renal disease patients undergoing predilution OL-HDF, the values of Qa measured by the OCM technique (Qa_OCMT) in a Fresenius 4008H HDF machine were compared with those determined by the standard ultrasound dilution technique (Qa_UDT). Results: The values of Qa_UDT and Qa_OCMT measured at the beginning of the HDF session were 800.5 ± 910.3 and 794.6 ± 895.4 ml/min (nonsignificant). There was a significant correlation between the two techniques (r = 0.95, p < 0.01). A Bland-Altman plot demonstrated a good agreement. Conclusion: The vascular access flow determined by OCM, which is integrated mostly in the current HDF machine, is highly accurate, easy to perform, and economical and can be used for vascular access surveillance in OL-HDF.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Measurement of Vascular Access Flow by Online Clearance Monitor in Online Hemodiafiltration

Tiranathanagul

Susantitaphong²,

Towannang³

et al. 2011

Blood Purif

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“…With reversed needles, fistula recirculation is forced. Qa is calculated as:

Q a = \frac{1 - R r}{R r * (1 - C P R)} \times (Q B r - U F R)

where CPR is cardiopulmonary recirculation:

C P R = \frac{R n \times (1 - R r)}{R r \times (1 - R n)} \times \frac{Q B r - U F R}{Q B n}

and Rn is recirculation with needles in their normal positions, Rr is recirculation with reversed needles, Qbn is Qb with normal needles, Qbr is Qb with reversed needles, and UFR is ultrafiltration rate.…”

Section: Methodsmentioning

confidence: 99%

Does the extracorporeal blood flow affect survival of the arteriovenous vascular access?

Ponce¹,

Marcelli

Scholz

et al. 2014

Hemodialysis International

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Hemodiafiltration with high-convective volumes is associated with improved patient survival, whereby practical realization is contingent on high extracorporeal blood flow (Qb) and dialysis treatment time. However, Qb is restricted by vascular access (VA) quality and/or concerns that high Qb could damage the VA. Taking VA quality into consideration, one can investigate the relationship between Qb and VA survival. We analyzed data from 1039 patients treated by hemodiafiltration over a 21-month period where access blood flow (Qa) measurements were also available at baseline. VA failure was defined as a surgical intervention resulting in the generation of a new VA. Qa was included as a stratification variable within a Cox regression model. A second Cox proportional hazard model with a penalized spline was used to describe the association between Qb and VA survival. Compared with Qb in the 350-357 mL/min range, a significantly higher hazard ratio (HR) for VA failure was detected for fistula only, and then only for Qb < 312 mL/min (HR: 2.361, 95% confidence interval [CI]: 1.251-4.453), Qb = 387-397 mL/min (HR: 1.920, 95% CI: 1.007-3.660) and Qb >414 mL/min (HR: 2.207, 95% CI: 1.101-4.424). Age, gender, diabetes, VA vintage, position of the VA, and arterial pressure were not significantly associated with outcome. The form of the penalized spline confirmed higher risk for VA failure for the lowest and the highest values of Qb. Taking Qa into consideration, no association was found between VA failure and Qb up to flows as high as approximately 390 mL/min.

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“…A validation of access flow calculations obtained by the Diascan showed a mean bias in the range of 100 mL/min and a 95% confidence interval of approximately 750 mL/min (Mercadal et al 1999). The validation of access flow calculations obtained by the OLC or OCM monitor showed a rather large bias and poor reproducibility when compared to the reference technique (Eloot et al 2010, Gotch et al 1999, Lacson et al 2008, Whittier et al 2009). This discrepancy could be due to technical differences of the on-line clearance measurement in both devices, the OLC-Monitor using two separate sensors for measuring dialysate inflow and outflow conductivities, and the Diascan using only one sensor.…”

Section: On-line Clearancementioning

confidence: 93%