title: Bedside screening for fistula stenosis should be tailored to the site of the arteriovenous anastomosis.
abstract: OBJECTIVE
  Given different sites of stenosis and access blood flow rates (Qa), the criteria for diagnosing fistula stenosis might vary according to anastomotic site. To test this, we analyzed the database of a prospective blinded study seeking an optimal bedside screening program for fistula stenosis.
  
  
  METHODS
  Several methods used during dialysis (physical examination [PE], dynamic and derived static venous pressure [VAPR], dialysis blood pump flow/arterial pressure ratio, and Qa measurement) to diagnose angiographically-proven >50% stenosis were assessed in an unselected population of hemodialysis patients with mature fistulae (43 at the wrist [distal fistulae], 76 at mid-forearm or the elbow [proximal fistulae]).
  
  
  RESULTS
  Prevalence of inflow stenosis was uninfluenced by anastomotic site, whereas outflow stenoses were more prevalent in proximal fistulae. The best test for inflow stenosis was Qa <650 ml/min in distal fistulae and a combination of a positive PE and Qa <900 ml/m in proximal fistulae. In proximal fistulae, PE and VAPR >0.5 were both equally highly diagnostic of outflow stenosis. Tailoring choice of test to site of the anastomosis may also contain the screening-associated workload, by reducing the need to perform PE and measure VAPR, compared with a screening approach regardless of the access location.
  
  
  CONCLUSIONS
  Our study shows that an effective bedside screening program with ≥85% accuracy for fistula stenosis can be tailored to the site of the anastomosis, Qa being the tool of choice for the wrist, and PE alone or combined with Qa and VAPR measurements for more proximally-located accesses.
authors: Emodialisi Borgo Roma–UOC Nefrologia e Dialisi dU, Azienda Ospedaliera Universitaria Integrata–Verona, Verona, Italy. nicola.tessitore@ospedaleuniverona.it
authors: Nicola
authors: N
authors: Tessitore
authors: Valeria
authors: V
authors: Bedogna
authors: Giovanni
authors: G
authors: Lipari
authors: Edoardo
authors: E
authors: Melilli
authors: William
authors: W
authors: Mantovani
authors: Elda
authors: E
authors: Baggio
authors: Antonio
authors: A
authors: Lupo
authors: Giancarlo
authors: G
authors: Mansueto
authors: Albino
authors: A
authors: Poli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000706:statistics & numerical data; D001794:Blood Pressure; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D011673:Pulsatile Flow; D006435:Renal Dialysis; D015203:Reproducibility of Results