Comparison of hemodialysis blood access flow rates using online measurement of conductivity dialysance and ultrasound dilution.
BACKGROUND
Routine access flow (AF) surveillance is recommended by the Kidney Disease Outcomes Quality Initiative as one of several components for an arteriovenous vascular access maintenance program. A reliable, but affordable, measurement tool is needed for outpatient hemodialysis facilities.


METHODS
Diagnostic test study.


METHODS
50 adult patients with 27 grafts and 23 fistulas from a single center who consented to sequential AF measurements, all performed within the first 90 minutes of the hemodialysis treatment.


METHODS
AF measured by using online conductivity dialysance (OLC-AF).


METHODS
AF measured by using ultrasound dilution (UD-AF).


RESULTS
Mean UD-AF was 1,086 +/- 629 mL/min, and mean OLC-AF was 951 +/- 575 mL/min, with a mean difference of 135 +/- 229 mL/min. OLC-AF correlated significantly with UD-AF (0.93; P < 0.0001), becoming tighter for flows less than 1,000 mL/min (0.95; P < 0.0001). The coefficient of variation for sequential measurement by using UD was 6.4%, and for OLC, 11.5%, with the difference becoming insignificant (7.6% versus 8.8%; P = 0.5) for flows less than 1,000 mL/min. The average of 2 sequential UD-AF measurements correlated tightly with that of OLC-AF (0.99; P < 0.0001).


CONCLUSIONS
Tests were performed by 2 highly trained coordinators in a single clinic with a small sample size, and clinical outcomes were not evaluated.


CONCLUSIONS
The OLC method is a reasonable alternative to UD for flow surveillance of arteriovenous hemodialysis accesses and provides an option for widespread implementation of a vascular access surveillance program. Additional studies are needed to determine whether routine use impacts on clinical outcomes.
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D010865:Pilot Projects; D006435:Renal Dialysis / Q000379:methods / Q000592:standards*; D014463:Ultrasonography