Korean J Transplant.  2023 Nov;37(Suppl 1):S301. 10.4285/ATW2023.F-9107.

Impacts of monthly arteriovenous fistula flow surveillance on hemodialysis access thrombosis and loss

• Ko A

• KMID: 2551930
• DOI: http://doi.org/10.4285/ATW2023.F-9107

Abstract

Background
Arteriovenous fistula flow dysfunction is the main cause of vascular access thrombosis and loss in hemodialysis patients. However, data on the influence of access flow rate measurement on the long-term outcomes of access are limited. The aim of this study was to identify access at a high risk of thrombosis and loss among hemodialysis patients by measuring access flow rate and to explore an optimal threshold value for predicting the future access thrombosis.
Methods
We enrolled 220 hemodialysis patients with arteriovenous fistula. The primary outcome was the occurrence of access thrombosis. Access flow rates were measured monthly with ultrasound dilution method and averaged using all measurements in patients with patent access.
Results
In patients experienced access thrombosis, those immediately before the thrombosis were selected. Using these, the threshold of access flow rate for the occurrence of thrombosis was calculated by the analysis of the receiver operating characteristic curve, and the patients were divided into two groups according to access flow rates higher or lower than 400 mL/min. During the median follow-up of 3.1 years, 4,510 access flow were measured (median measurements per patient, 33 times; interquartile range, 11–54 times). Sixty-five access thromboses and 19 abandonments occurred. When the occurrence of access thrombosis and loss were compared between the two groups, the low flow group had increased access thrombosis and loss than the high flow group.
Conclusions
This study showed that low access flow rates detected is strongly associated with the occurrence of thrombosis and subsequent loss of arteriovenous fistula in hemodialysis patients.