Static intra-access pressure ratio does not correlate with access blood flow.
BACKGROUND
Access flow (Qa) measurement is recommended by Kidney Disease Outcomes Quality Initiative (K/DOQI) as the preferred method for access surveillance. Static intra-access pressure ratio (SIAPR) measurement is the second surveillance method of choice. The purpose of this prospective multicenter study was to investigate the relationship between SIAPR and Qa and to examine the premise upon which SIAPR surveillance is based-namely, that high SIAPR is a surrogate for low Qa associated with hemodynamically significant stenosis.


METHODS
SIAPR and Qa (HD01; Transonic Systems, Inc., Ithaca, NY, USA) were simultaneously measured monthly in 242 patients [146 prosthetic arteriovenous bridge grafts (AVG), 96 autogenous arteriovenous fistulas (AVF)] from three centers. SIAPR was measured according to the K/DOQI protocol.


RESULTS
There was no correlation between Qa and venous or arterial SIAPR in AVGs (R(2)= 0.0037 and R(2)= 0.006, respectively, N= 730), or in AVFs (R(2)= 0.0247 and R(2)= 0.0329, respectively, N= 431). Of the high SIAPR measurements in AVGs, 81% and 50% were associated with Qa > or =600 and Qa > or =1000 mL/min, respectively. Of the AVGs studied, 41% (60/146) had consistently high Qa > or =1000 mL/min. Seventy percent (42/60) of these high-Qa AVGs had at least two consecutive sessions with high SIAPR measurements, thereby meeting the K/DOQI SIAPR criteria for referral. In addition, 78% (14/18) of new AVGs with Qa > or =1000 mL/min, and 86% (6/7) of AVGs with the highest Qa (> or =2000 mL/min), had high SIAPR. As a result, these high-Qa AVGs, which represented the best functioning AVGs by K/DOQI Qa standards, were erroneously targeted for referral based on SIAPR measurements.


CONCLUSIONS
SIAPR does not correlate with Qa or discriminate between high and low Qa. Therefore, because the utility of SIAPR surveillance for detection of clinically significant stenosis depends on a correlation with Qa, the current use of absolute K/DOQI SIAPR thresholds for intervention based on the presumption that such thresholds are indicative of low Qa is not justified, and should be discontinued. Studies need to be done to examine the utility of SIAPR for trend analysis.
Spergel
Lawrence M
LM
Dialysis Management Medical Group, San Francisco, California 94109, USA. vampdoc@aol.com
Holland
Janet E
JE
Fadem
Stephen Z
SZ
McAllister
Charles J
CJ
Peacock
Eileen J
EJ
D001166:Arteriovenous Shunt, Surgical; D001794:Blood Pressure; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008955:Models, Cardiovascular; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis; D014159:Transducers