Vascular Access Monitoring and Surveillance: An Update

Valliant, Amanda; McComb, Kathryn

doi:10.1053/j.ackd.2015.06.002

Cited by 15 publications

(11 citation statements)

References 33 publications

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“…Kt/V is an objective parameter used in determining dialysis adequacy [2]. In AVF dysfunction, adequate dialysis cannot be provided and Kt/V rates decrease [33]. Kt/V value alone not enough to identify AVF dysfunction, however, and it is recommended to evaluate this parameter together with physical examination [2].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing arteriovenous fistulas: A multicenter study

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2021

Ther Apher Dial

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In this cross-sectional, descriptive study, the arteriovenous fistulas (AVF) of HD patients were evaluated by physical examination and factors associated with AVF function and longevity were investigated. Data were collected using a patient information form and the Arteriovenous Fistula Assessment Scale (AVF-AS). The study population included 279 patients under chronic HD treatment. Their mean age was 61.14 ± 14.00 years and 58.6% were men. Age, AVF location, and number of AVFs created were identified as factors associated with AVF needle entry site and flow problems, stenosis, and risk of developing ischemic complications (p = 0.005, p = 0.000, p = 0.006, respectively). AVF dysfunction adversely affected HD pump speed (p = 0.000) and HD adequacy (p = 0.000). It was determined that gender, AVF location, last AVF duration, and total number of previous AVF were identified as the risk of AVF complications. The results of this study revealed that regular follow-up and evaluation are needed to minimize the risk of dysfunction and failure due to AVF complications.

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Section: Discussionmentioning

confidence: 99%

Factors influencing arteriovenous fistulas: A multicenter study

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2021

Ther Apher Dial

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“…[7][8][9] The clinical benefit and cost effectiveness of AVF surveillance regimens are a subject of debate. 1,3,[9][10][11][12] Updated guidelines from the European Renal Best Practice (ERBP) and The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) have found that the available evidence is inconclusive to make a recommendation on AVF surveillance and they do not suggest routine surveillance of grafts. 1,12 Several volume flow rate (VFR) quantification modalities are available.…”

Section: Introductionmentioning

confidence: 99%

Validation of a novel ultrasound Doppler monitoring device (earlybird) for measurements of volume flow rate in arteriovenous fistulas for hemodialysis

et al. 2021

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Background: Controversy exists regarding surveillance of arteriovenous fistulas for hemodialysis to increase patency. A significant reduction in volume flow rate (VFR) should lead to diagnostic evaluation and eventually intervention. Several methods are available for VFR measurements, but all of them are associated with low reproducibility. VFR trend analysis is suggested as an improved solution. It is therefore a need to find user-friendly, cost and time-effective modalities. We present a novel Doppler ultrasound device (earlybird) which could bridge this gap. It includes an easy-to-use and light-weight single element transducer. Methods: In an experimental and clinical setting, we compared earlybird to duplex ultrasound to assess VFR. In a closed circuit of blood-mimicking fluid, 36 paired calculations of calibrated, duplex ultrasound and earlybird VFR was measured. In addition, 23 paired recordings of duplex ultrasound and earlybird VFR was measured in 16 patients with underarm arteriovenous fistulas. Pearson correlation, intraclass correlation coefficient, root-mean-square and Bland-Altman plots were analyzed. Results: Strong correlation ( r = 0.991, p < 0.001), and excellent level of agreement (ICC = 0.970 (95% CI 0.932 - 0.985), p < 0.001) between earlybird and the calibrated VFR was found in the experimental setup. This was confirmed in the clinical setting, with a strong correlation ( r = 0.781, p < 0.001) and moderate to good level of agreement (ICC = 0.750 (95% CI 0.502–0.885), p < 0.001) between earlybird and duplex ultrasound VFR measured at the arteriovenous fistulas outflow veins. In the Bland-Altman plot-analysis for the experimental setup, we found smaller limits of agreement, a smaller consistent and proportional bias, as well as greater accuracy of earlybird than DUS when compared to the calibrated VFR. Conclusion: Earlybird is a feasible tool for VFR measurements and could be a future promising device for easy assessment and surveillance of AVF for hemodialysis.

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“…[5][6][7][8] However, preemptive percutaneous transluminal angioplasty (PTA) for vascular access stenosis may decrease the rate of AVG failure and has a better patency rate than thrombectomy for occlusion. [9][10][11] Therefore, the ability to predict impending AVG occlusions would allow for interventions to prolong the longevity of an AVG. In addition, because AVG occlusion is commonly identified prior to starting dialysis, patients are often forced to postpone dialysis treatments while awaiting intervention, which may increase the risk of hyperkalemia or fluid overload, especially after the weekend.…”

Section: Introductionmentioning

confidence: 99%

The role of venous pressure variability during hemodialysis in the prediction of impending arteriovenous graft occlusion

et al. 2021

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Background: Elevated venous pressure during hemodialysis (VPHD) is associated with arteriovenous graft (AVG) stenosis. This study investigated the role of VPHD variations in the prediction of impending AVG occlusion. Methods: Data were retrieved from 118 operations to treat AVG occlusion (occlusion group) and 149 operations to treat significant AVG stenosis (stenosis group). In addition to analyzing the VPHD values for the three hemodialysis (HD) sessions prior to the intervention, VPHD values were normalized to mean blood pressure (MBP), blood flow rate (BFR), BFR × MBP, and BFR2 × MBP to yield ratios for analysis. The coefficient of variation (CV) was used to measure relative variations. Results: The within-group comparisons for both groups revealed no significant differences in the VPHD mean and CV values among the three HD sessions prior to intervention. However, the CVs for VPHD/MBP, VPHD/(BFR × MBP), and VPHD/(BFR2 × MBP) exhibited significant elevation in the occlusion group during the last HD session prior to intervention compared with both the penultimate and antepenultimate within-group HD data ( p < 0.05). In the receiver operating characteristic curve analysis, the CV for VPHD/(BFR2 × MBP) was the only parameter able to discriminate between the last and the penultimate HD outcomes ( p < 0.001). According to a multivariate analysis, after controlling for covariates, CV for VPHD/(BFR2 × MBP) >8.76% was associated with a higher risk of AVG thrombosis (odds ratio: 3.17, p < 0.001). Conclusions: Increasing the variation in VPHD/(BFR2 × MBP) may increase the probability of AVG occlusion.

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Vascular Access Monitoring and Surveillance: An Update

Cited by 15 publications

References 33 publications

Factors influencing arteriovenous fistulas: A multicenter study

Factors influencing arteriovenous fistulas: A multicenter study

Validation of a novel ultrasound Doppler monitoring device (earlybird) for measurements of volume flow rate in arteriovenous fistulas for hemodialysis

The role of venous pressure variability during hemodialysis in the prediction of impending arteriovenous graft occlusion

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