Comparison of urea recirculation and thermodilution for monitoring of vascular access in patients undergoing hemodialysis

Vega, Almudena; Abad, Soraya; Aragoncillo, Inés; Galán, Isabel; Macías, Nicolás; Cedeño, Santiago; Santos, Alba; García, Ana Rodríguez; Liñares, Tania; Martínez-Villaescusa, María; López‐Gómez, Juan M.

doi:10.1177/1129729817747536

“…(14) Urea recirculation, which calculated access flow from inducing urea recirculation by reversing bloodline had a high sensitivity and specificity in detecting needed for intervention. However, this method works well for low blood flow, whereas insensitive at high flow (12,15) Color Doppler ultrasonography can evaluate the access flow and identify the stenosis sites in the AVF (16) but, is operator dependent and time-consuming. Several studies have shown the benefit of noninvasive monitoring tools for detecting vascular access stenosis (12,(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Comparing Non-invasive Diagnostic Methods for Arteriovenous Fistula Stenosis: A Prospective Study

Raksasuk

¹

,

Rojwatcharapibarn

²

,

Srithong

³

2020

Preprint

0

View full text Add to dashboard Cite

Background International guidelines recommended screening for AVF stenosis using various non-invasive methods. The previous studies have reported conflicting results. This study aims to evaluate the utility of the different non-invasive AVF flow measurements for detecting AVF stenosis. Methods We evaluated 23 HD patients with the clinical suspicion for AVF stenosis based on physical examination or high venous pressures during. Patients underwent all three non-invasive measurements including ultrasound dilution, urea dilution, and Doppler ultrasonography. Fistulography was performed to confirm the degree of AVF stenosis in all patients. Results Fistulography revealed AVF stenosis in eighteen patients, twelve of whom had severe stenosis (greater than 50% stenosis). About the location of the stenotic lesions, eight were at the inflow site, six at the outflow site, and four at both sites. In those AVFs with severe stenosis, median access flows were 625 mL/min by ultrasound dilution method, 615 mL/min by urea dilution method, and 590 mL/min by Doppler ultrasonography. Receiver operating characteristic (ROC) curve analysis showed that Doppler ultrasonography had a high discriminative ability and the averaged areas under the curves were 0.933 (95% confidence interval [CI], 0.81 to 0.99) for stenosis and 0.929 (95% CI, 0.82 to 0.99) for severe stenosis. The sensitivity of each method for prediction of access stenosis was 73%, 73%, 80% by using the ultrasound dilution, urea dilution, and Doppler ultrasonography methods, respectively. The specificity of each method was 40%, 80%, and 100% respectively. Physical examination showed 80% sensitivity and 80% specificity for detecting AVF stenosis. The combination of non-invasive access flow measurement with physical examination increased the sensitivity for detection of AVF stenosis to 80%, 93%, and 93% respectively. Conclusions Doppler ultrasound combine with physical examination, was more accurate than other non-invasive methods for detection of AVF stenosis.

show abstract

“…Urea recirculation, which calculated access ow from inducing urea recirculation by reversing bloodline had a high sensitivity and speci city in detecting needed for intervention. However, this method works well for low blood ow, whereas insensitive at high ow [13,16] Additionally, ultrasound dilution and urea circulation methods are strongly related to blood pressure and it might be better to calculate a ratio between the measured access ow and blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Comparing Non-invasive Diagnostic Methods for Arteriovenous Fistula Stenosis: A Prospective Study

Raksasuk

¹

,

Rojwatcharapibarn

²

,

Srithongkul

³

2020

Preprint

0

View full text Add to dashboard Cite

Background International guidelines recommended screening for AVF stenosis using various non-invasive methods. The previous studies have reported conflicting results. This study aims to evaluate the utility of the different non-invasive AVF flow measurements for detecting AVF stenosis. Methods We evaluated 23 HD patients with the clinical suspicion for AVF stenosis based on physical examination or high venous pressures during. Patients underwent all three non-invasive measurements including ultrasound dilution, urea dilution, and Doppler ultrasonography. Fistulography was performed to confirm the degree of AVF stenosis in all patients. Results Fistulography revealed AVF stenosis in eighteen patients, twelve of whom had severe stenosis (greater than 50% stenosis). About the location of the stenotic lesions, eight were at the inflow site, six at the outflow site, and four at both sites. In those AVFs with severe stenosis, median access flows were 625 mL/min by ultrasound dilution method, 615 mL/min by urea dilution method, and 590 mL/min by Doppler ultrasonography. Receiver operating characteristic (ROC) curve analysis showed that Doppler ultrasonography had a high discriminative ability and the averaged areas under the curves were 0.933 (95% confidence interval [CI], 0.81 to 0.99) for stenosis and 0.929 (95% CI, 0.82 to 0.99) for severe stenosis. The sensitivity of each method for prediction of access stenosis was 73%, 73%, 80% by using the ultrasound dilution, urea dilution, and Doppler ultrasonography methods, respectively. The specificity of each method was 40%, 80%, and 100% respectively. Physical examination showed 80% sensitivity and 80% specificity for detecting AVF stenosis. The combination of non-invasive access flow measurement with physical examination increased the sensitivity for detection of AVF stenosis to 80%, 93%, and 93% respectively. Conclusions Doppler ultrasound combine with physical examination, was more accurate than other non-invasive methods for detection of AVF stenosis.

show abstract

Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit

Degraeve

¹

,

Danse

²

,

Laterre

³

et al. 2019

View full text Add to dashboard Cite

Comparison of urea recirculation and thermodilution for monitoring of vascular access in patients undergoing hemodialysis

Abstract: Urea recirculation is better predictor of vascular access dysfunction than thermodilution.

Cited by 7 publications

References 26 publications

Comparing Non-invasive Diagnostic Methods for Arteriovenous Fistula Stenosis: A Prospective Study

Comparing Non-invasive Diagnostic Methods for Arteriovenous Fistula Stenosis: A Prospective Study

Comparing Non-invasive Diagnostic Methods for Arteriovenous Fistula Stenosis: A Prospective Study

Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit

Contact Info

Product

Resources

About