Detection of Vascular Access Stenosis by Measurement of Access Blood Flow from Ionic Dialysance

Mercadal, Lucile; Challier, E; Cluzel, Philippe; Hamani, Abdelaziz; Boulechfar, Hacène; Boukhalfa, Zhora; Izzedine, Hassane; Bassilios, Nader; Barrou, B.; Deray, Gilbert; Petitclerc, Thierry

doi:10.1159/000047006

Cited by 17 publications

(9 citation statements)

References 18 publications

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“…Clinical validation in HD patients showed a significant correlation with the ultrasound dilution method, taken as a reference [31,32]. A recent study evaluated the possibility of detecting vascular access stenosis by measurement of access blood flow from ionic dialysance [33]. Twenty-three patients had Qa evaluated by the ionic dialysance method and by the ultrasound dilution technique during the same dialysis session.…”

Section: Ionic Dialysance and Vascular Access Monitoringmentioning

confidence: 99%

Haemodialysis with on-line monitoring equipment: tools or toys?

Locatelli

Buoncristiani²,

Canaud³

et al. 2005

Nephrology Dialysis Transplantation

115

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On-line monitoring devices and bio-feedback systems have evolved from toys for research use to tools for routine clinical application, particularly in patients with clinical complications. Conductivity monitoring appears the most versatile tool, as it permits quantification of delivered dialysis dose, achievement of sodium balance and surveillance of vascular access function, potentially at each dialysis session and without extra cost.

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Section: Ionic Dialysance and Vascular Access Monitoringmentioning

confidence: 99%

Haemodialysis with on-line monitoring equipment: tools or toys?

Locatelli

Buoncristiani²,

Canaud³

et al. 2005

Nephrology Dialysis Transplantation

115

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“…Mercadal assessed ID and compared access blood flow (Qa-ID), calculated by the ID method, to that obtained using the reference saline dilution method, Qa-T, in 28 patients. 7,15 Both methods were highly correlated: Qa-ID = 1.24*Qa-T (r 2 = 0.86, P < 0.0001). The difference between Qa-ID and Qa-T was 107 ± 387 mL/minute, suggesting that the ID method was better at predicting thrombosis of the vascular access when Qa was < 500 mL/minute, compared to stenosis detected by ultrasonography.…”

Section: Discussionmentioning

confidence: 96%

“…Mercadal assessed ID and compared access blood flow (Qa‐ID), calculated by the ID method, to that obtained using the reference saline dilution method, Qa‐T, in 28 patients . Both methods were highly correlated: Qa‐ID = 1.24*Qa‐T (r 2 = 0.86, P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Transonic, thermodilution, or ionic dialysance to manage vascular access: Which method is best?

Badr

Bories

Marais

et al. 2013

Hemodialysis International

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Regularly monitoring blood flow through a vascular access (Qa) can predict a dysfunction and dramatically reduce the number of thromboses. The aim of our study was to compare two integrated access flow devices, thermodilution (Qa-BTM: BTM(®), Fresenius Medical Care, Bad Homburg, Germany) and ionic dialysance (Qa-ID: OCM(®), Fresenius Medical Care, Bad Homburg, Germany), with the "gold standard" saline dilution (Qa-T: Transonic(®), Systems Inc., Ithaca, NY, USA). Measurements were performed sequentially and were repeated in the first 90 minutes of a single dialysis session in 24 long-term hemodialysis patients with a vascular access. Bland-Altman, linear regression (r(2)), and intraclass correlation coefficients (ICC) assessed reproducibility, correlations, and concordance between the techniques. Average access flow for Qa-T was 1549 (± 844) mL/minute, Qa-BTM was 1530 (± 856) mL/minute (P = NS), and Qa-ID was 1619 (± 1085) mL/minute (P = NS). Respectively, ICC, (r(2)), and bias were 0.99, (0.98), and -19 mL/minute for Qa-BTM, and 0.75, (0.65), and +69 mL/minute for Qa-ID. The limits of agreement were -287 to +250 mL/minute for Qa-BTM and -1647 to +1785 mL/minute for Qa-ID. Reproducibility of thermodilution and ionic dialysance, expressed as relative differences, was not significantly different from saline dilution. Recirculation, measured by saline dilution, was 0% (0-4%), the same as the 0% measured by thermodilution, with correct placement of bloodlines and corrected for cardiopulmonary recirculation. The integrated access flow measurement devices, thermodilution and ionic dialysance, are reasonable alternatives to using saline dilution to measure Qa: Thermodilution showed better precision and correlation. They are reliable, make monitoring of vascular access easier, incur no extra costs, and use no additional consumables.

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“…The analysis is done by a trained operator who is able to identify the aspects typical of vascular access dysfunction. This surveillance procedure has been implemented successfully in the early detection of arteriovenous fistulae dysfunction (3)(4)(5)(6). The increased amount of collected data from medical devices can help to improve care quality.…”

Section: Automatic Vascular Access Evaluationmentioning

confidence: 99%

Clinical Evaluation of An Expert System for Arteriovenous Fistula Assessment

Chanliau¹,

Charasse

Rose

et al. 2014

Int J Artif Organs

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The monitoring of ionic dialysance in hemodialysis allows early detection of arterio-venous fistula stenosis. One limitation to the practical use of ionic dialysance is that the analysis is very time consuming on a majority of normal cases. The purpose of the study is to evaluate the utility of an expert system reproducing a human analysis and allowing continuous monitoring of the ionic dialysance by helping the physician to focus his or her expertise on the abnormal cases. The method is based on a Bayesian model that analyzes the blood flow rate, the ionic dialysance, and the venous and arterial pressures measured on the extra corporeal circuit. The clinical evaluation was performed on 90 dialysis patients at the hospital dialysis center of Saint Brieux in France with a history of at least four consecutive months of validated recording. The retrospective automated analysis was evaluated in comparison to vascular access problems identified from invasive investigation or treatment. The sensitivity of the automated analysis is 92% with a specificity of 75%. As a conclusion we suggest that this expert system could be used in a continuous vascular access monitoring procedure consisting in a weekly review of the patient population at the dialysis center. The patients with the highest risk score need a further investigation of their historical data and their medical history in order to decide whether or not to perform an invasive intervention.

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Detection of Vascular Access Stenosis by Measurement of Access Blood Flow from Ionic Dialysance

Cited by 17 publications

References 18 publications

Haemodialysis with on-line monitoring equipment: tools or toys?

Haemodialysis with on-line monitoring equipment: tools or toys?

Transonic, thermodilution, or ionic dialysance to manage vascular access: Which method is best?

Clinical Evaluation of An Expert System for Arteriovenous Fistula Assessment

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