title: Comparison of hemodialysis blood access flow rates using online measurement of conductivity dialysance and ultrasound dilution.
abstract: 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.
authors.affiliation: Fresenius Medical Care, North America, Waltham, MA 02451-1457, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lacson
authors.forename: J Michael
authors.initials: JM
authors.lastname: Lazarus
authors.forename: Roy
authors.initials: R
authors.lastname: Panlilio
authors.forename: Frank
authors.initials: F
authors.lastname: Gotch
mesh_terms: 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