Glucose Pump Technique is as Good as Ultrasound Dilution Technique for Vascular Access Surveillance in Hemodialysis Patients

Ha, Sang Jin; Lee, Yoon Jung; Cho, Byung Hyun; Jung, Kyung Hwan; Moon, Joo Yung; Lee, Sang Ho; Lee, Tae Won; Ihm, Chun Gyoo

Abstract

PURPOSE: Vascular access flow (Qa) measurements are important in the surveillance protocol of hemodialysis vascular access stenosis. The glucose pump technique (GPT) is a technique for Qa measurement based on the dilution technique of a constant glucose infusion that was introduced in 1995. The aim of this study is to verify the clinical efficacy of GPT in vascular access surveillance compared with ultrasound dilution technique.
METHODS
In 31 chronic hemodialysis patients with a AV fistula, we compared Qa measurements performed with GPT in pre-dialysis and the ultrasound dilution technique (Transonic HD01, Transonic System Inc., Ithaca, NY) during hemodialysis.
RESULTS
Mean Qa was 1171 ml/min by GPT versus 1028 ml/min by HD01 (p=0.262). There was a strong linear correlation between the two methods (r=0.61; p<0.01). Ultrasound dilution technique HD01 yielded 6 cases of high risk Qa measurements and GPT yielded 4 cases of high risk Qa measurements. The diagnostic accuracy of GPT tested with the ROC curve was similar with ultrasound dilution technique HD01. The specificity and sensitivity was 80% and 66.7% according to Qa=600 ml/min. But sensitivity was 83.3% according to Qa=750 ml/min.
CONCLUSION
GPT offers the advantage of a simple and economic bedside procedure easily performed before dialysis and had a similar diagnostic accuracy and efficiency compared with ultrasound dilution technique HD01.