Access flow in arteriovenous accesses by optodilutional and ultrasound dilution methods.
BACKGROUND
Most large studies evaluating the diagnostic properties of access blood flow (Qa) in arteriovenous (AV) accesses have used the Transonic HD01 (Transonic Systems Inc, Ithaca, NY) device, and recommended thresholds for angiography are based on data from these studies. There has been little exploration of how the use of other devices might affect the feasibility or performance of screening in AV accesses.


METHODS
We compared 2 devices for measuring Qa: the Transonic HD01 and the Crit-Line TQA III (Hemametrics, Salt Lake City, UT). We studied 124 adults with end-stage renal disease and a functioning AV access (fistula or graft). Qa was measured with both devices in immediate succession during a single dialysis treatment. The primary outcome was the technical feasibility of the Qa measurement. We also compared mean Qa values measured by the Crit-Line III and Transonic devices.


RESULTS
Qa measurements were less likely to be technically feasible when the Crit-Line III device was used compared with the Transonic device (86.3% versus 100%; P < 0.001). In patients with valid measurements, mean Qa measured using the Crit-Line III was significantly less than that measured using the Transonic HD01 device (886 +/- 557 versus 1,148 +/- 685 mL/min; P < 0.001). The mean difference was 261 mL/min (95% confidence interval [CI], 117 to 405) and was greater at higher levels of Qa. On average, Qa measured by means of the Crit-Line III device was 73% as high as that measured using the Transonic device (95% CI, 63 to 84). There was poor agreement between devices about whether criteria for angiography were met (kappa < 0.1). The proportion of patients for whom angiography was indicated (based on results from the Crit-Line device) was significantly greater than when only results from the Transonic device were considered (40.3% versus 7.3%; P < 0.001).


CONCLUSIONS
Consideration should be given to device-specific Qa thresholds for angiography or, alternatively, standardization of Qa results between manufacturers. Clinicians should be aware that Qa results cannot be compared directly between different devices, and access monitoring should be performed using a single technique in any given patient. Additional studies are required before the Crit-Line TQA device can be recommended for widespread use.
Tonelli
Marcello
M
Department of Medicine, University of Alberta, Alberta, Canada. mtonelli@ualberta.ca
Klarenbach
Scott
S
Jindal
Kailash
K
Harries
Sarah
S
Zuidema
Sylvia
S
Caldwell
Steven
S
Pannu
Neesh
N
D015502:Absorptiometry, Photon; D000368:Aged; D000792:Angiography / Q000706:statistics & numerical data*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002408:Catheters, Indwelling; D003251:Constriction, Pathologic; D005240:Feasibility Studies; D005260:Female; D006454:Hemoglobins / Q000528:radiation effects; D018056:Hemorheology / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007201:Indicator Dilution Techniques; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D015203:Reproducibility of Results; D014463:Ultrasonography
D006454:Hemoglobins