Dynamic venous access pressure ratio test for hemodialysis access monitoring

Frinak, Stanley; Zasuwa, Gerard; Dunfee, Thomas P.; Besarab, Anatole; Yee, Jerry

doi:10.1053/ajkd.2002.35687

Cited by 48 publications

(42 citation statements)

References 17 publications

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“…This cut-off is similar to the one reported for detecting stenoses in grafts (11), supporting the notion that proximal AVFs with outflow stenoses behave hemodynamically like grafts (1). PE and VAPR Ͼ0.5 both had an equally excellent diagnostic profile, although PE can be considered as the screening procedure of choice because it can be used for all AVFs, and it is more straightforward to perform and less variable than VAPR (8a).…”

Section: Discussionsupporting

confidence: 83%

Bedside Screening for Fistula Stenosis Should Be Tailored to the Site of the Arteriovenous Anastomosis

Tessitore¹,

Bedogna²,

Lipari³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Given different sites of stenosis and access blood flow rates (Qa), the criteria for diagnosing fistula stenosis might vary according to anastomotic site. To test this, we analyzed the database of a prospective blinded study seeking an optimal bedside screening program for fistula stenosis.Design, setting, participants, & measurements Several methods used during dialysis (physical examination [PE], dynamic and derived static venous pressure [VAPR], dialysis blood pump flow/arterial pressure ratio, and Qa measurement) to diagnose angiographically-proven Ͼ50% stenosis were assessed in an unselected population of hemodialysis patients with mature fistulae (43 at the wrist [distal fistulae], 76 at midforearm or the elbow [proximal fistulae]).Results Prevalence of inflow stenosis was uninfluenced by anastomotic site, whereas outflow stenoses were more prevalent in proximal fistulae. The best test for inflow stenosis was Qa Ͻ650 ml/min in distal fistulae and a combination of a positive PE and Qa Ͻ900 ml/m in proximal fistulae. In proximal fistulae, PE and VAPR Ͼ0.5 were both equally highly diagnostic of outflow stenosis. Tailoring choice of test to site of the anastomosis may also contain the screening-associated workload, by reducing the need to perform PE and measure VAPR, compared with a screening approach regardless of the access location. ConclusionsOur study shows that an effective bedside screening program with Ն85% accuracy for fistula stenosis can be tailored to the site of the anastomosis, Qa being the tool of choice for the wrist, and PE alone or combined with Qa and VAPR measurements for more proximally-located accesses.

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Section: Discussionsupporting

confidence: 83%

Bedside Screening for Fistula Stenosis Should Be Tailored to the Site of the Arteriovenous Anastomosis

Tessitore¹,

Bedogna²,

Lipari³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…The SIAPR method is based on the presumption that high SIAPR is an indirect indicator of low Qa associated with hemodynamically significant stenosis [2,3], and the value and utility of SIAPR for surveillance is therefore dependent on such a relationship existing between SIAPR and Qa. In fact, a number of studies have suggested that no correlation exists between SIAPR and Qa [5][6][7][8][9][10], while others suggest that this relationship does exist [2,3,11,12]. We could not find a published mathematical or theoretical basis for a correlation or surrogate relationship between SIAPR and Qa.…”

Section: Discussionmentioning

confidence: 61%

Static intra-access pressure ratio does not correlate with access blood flow

Spergel¹,

Holland²,

Fadem³

et al. 2004

Kidney International

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SIAPR does not correlate with Qa or discriminate between high and low Qa. Therefore, because the utility of SIAPR surveillance for detection of clinically significant stenosis depends on a correlation with Qa, the current use of absolute K/DOQI SIAPR thresholds for intervention based on the presumption that such thresholds are indicative of low Qa is not justified, and should be discontinued. Studies need to be done to examine the utility of SIAPR for trend analysis.

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“…The decrease in Q a is accompanied by an increase in intragraft pressure proximal to the stenosis. This pressure increase is the basis of VP monitoring [4] . Stenosis is usually treated with repeated PTA until the graft eventually fails.…”

Section: Does Monitoring Accurately Predict Outcomes?mentioning

confidence: 99%

“…In addition, advances in monitoring methods have made it easier to evaluate access function. For example, ultrasound dilution allows easy measurement of access blood fl ow (Q a ) [3] , and methods of measuring venous pressure (VP) have undergone important refi nements [4] . These developments have prompted a number of studies that have further evaluated the effi cacy of monitoring with intervention.…”

Section: Introductionmentioning

confidence: 99%

Access Monitoring Does Not Really Improve Outcomes

Paulson¹

2005

Blood Purif

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It is widely accepted that hemodialysis access monitoring combined with preemptive percutaneous transluminal angioplasty (PTA) improves outcomes. The many studies that have evaluated monitoring during the last decade provide an opportunity to examine whether this hypothesis is valid. Because synthetic grafts are more likely than autogenous arteriovenous fistulas to benefit from monitoring, this review is restricted to grafts. Recent studies show that monitoring does not accurately predict graft thrombosis or failure, nor does it prolong graft life. However, monitoring can reduce thrombosis, and thereby reduce access-related hospitalizations and use of central venous dialysis catheters. Because preemptive PTA is expensive, however, monitoring does not reduce the cost of access-related care. The limited benefit that monitoring provides emphasizes the urgent need to develop better approaches to solving the problem of graft thrombosis and failure.

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Dynamic venous access pressure ratio test for hemodialysis access monitoring

Cited by 48 publications

References 17 publications

Bedside Screening for Fistula Stenosis Should Be Tailored to the Site of the Arteriovenous Anastomosis

Bedside Screening for Fistula Stenosis Should Be Tailored to the Site of the Arteriovenous Anastomosis

Static intra-access pressure ratio does not correlate with access blood flow

Access Monitoring Does Not Really Improve Outcomes

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