J Korean Med Sci.  2010 May;25(5):728-733. 10.3346/jkms.2010.25.5.728.

Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

• Kim HS
• Park JW
• Chang JH
• Yang J
• Lee HH
• Chung W
• Park YH
• Kim S

• KMID: 1713957
• DOI: http://doi.org/10.3346/jkms.2010.25.5.728

Abstract

The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.

Keyword

Renal Dialysis; Blood Flow Velocity; Vascular Patency; Indicator Dilution Techniques

MeSH Terms

Blood Vessel Prosthesis/*statistics & numerical data
Female
Graft Occlusion, Vascular/*diagnosis/*epidemiology
*Graft Survival
Humans
Indicator Dilution Techniques/statistics & numerical data
Kidney Function Tests/*statistics & numerical data
Korea/epidemiology
Male
Middle Aged
Prevalence
Prognosis
Renal Dialysis/*statistics & numerical data
Reproducibility of Results
Risk Assessment
Risk Factors
Sensitivity and Specificity
Treatment Outcome
*Vascular Patency

Figure

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  Fig. 1 Cumulative incidence of new vascular access events.

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  Fig. 2 Stenosis-free survival according to the average vascular access blood flow (VABF): (A) Stenosis-free survival in patients with arteriovenous fistulae (AVF) and (B) in patients with arteriovenous grafts (AVG). The dotted lines represent the patients in the lowest quartile of average early VABF (<853 mL/min in AVF and <830 mL/min in AVG), and the solid lines represent the patients in the other quartiles (P=0.003).

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