Early vascular access blood flow as a predictor of long-term vascular access patency in incident hemodialysis patients.
The long-term clinical benefits of vascular access blood flow (VABF) measurements in hemodialysis (HD) patients have been controversial. We evaluated whether early VABF may predict long-term vascular access (VA) patency in incident HD patients. We enrolled 57 patients, of whom 27 were starting HD with arteriovenous fistulas (AVFs) and 30 with arteriovenous grafts (AVGs). The patients' VABF was measured monthly with the ultrasound dilution technique over the course of the first six months after the VA operation. During the 20.4-month observational period, a total of 40 VA events in 23 patients were documented. The new VA events included 13 cases of stenosis and 10 thrombotic events. The lowest quartile of average early VABF was related to the new VA events. After adjusting for covariates such as gender, age, hypertension, diabetes, VA type, hemoglobin levels, body mass index, parathyroid hormone, and calcium-phosphorus product levels, the hazard ratio of VABF (defined as <853 mL/min in AVF or <830 mL/min in AVG) to incident VA was 3.077 (95% confidence interval, 1.127-8.395; P=0.028). There were no significant relationships between early VABF parameters and VA thrombosis. It is concluded that early VABF may predict long-term VA patency, particularly VA stenosis.
Kim
Hyung Soo
HS
Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
Park
Jin-Woong
JW
Chang
Jae Hyun
JH
Yang
Jaeseok
J
Lee
Hyun Hee
HH
Chung
Wookyung
W
Park
Yeon Ho
YH
Kim
Sejoong
S
D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007201:Indicator Dilution Techniques / Q000706:statistics & numerical data; D007677:Kidney Function Tests / Q000706:statistics & numerical data*; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014654:Vascular Patency