Observational Study of Surveillance Based on the Combination of Online Dialysance and Thermodilution Methods in Hemodialysis Patients with Arteriovenous Fistulas

Abstract

Background/Aims: Online dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs. This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group. Methods: We studied 148 hemodialysis patients with arteriovenous fistulas (control group, n = 74) for 2 years. During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa <500 ml/min (or a decrease in flow >20%). Results: During the study period, we detected 16 cases of vascular dysfunction. The Kt value after vascular treatment was 71.1 liters (59 liters; p = 0.001) and BTM-Qa was 1,218.6 ml/min (519.7 ml/min; p = 0.001). Compared with the control group, the thrombosis rate was 0.027 versus 0.148 episodes/patient-year (p = 0.009) and the total access-related cost was EUR 22,293 versus 47,467 (p = 0.033). Conclusions: This study suggests that a combined monitoring program based on Kt and BTM-Qa represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments.

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

“…Ultrasound makes it possible to monitor VA flow and to detect dysfunctions such as stenosis. [32][33][34][35][36] While chair-side ultrasound would be optimal, measurement of recirculation is a quick and informative measure that can be obtained when imaging is not available.…”