title: Observational study of surveillance based on the combination of online dialysance and thermodilution methods in hemodialysis patients with arteriovenous fistulas.
abstract: OBJECTIVE
  Online dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs. This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group.
  
  
  METHODS
  We studied 148 hemodialysis patients with arteriovenous fistulas (control group, n = 74) for 2 years. During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa <500 ml/min (or a decrease in flow >20%).
  
  
  RESULTS
  During the study period, we detected 16 cases of vascular dysfunction. The Kt value after vascular treatment was 71.1 liters (59 liters; p = 0.001) and BTM-Qa was 1,218.6 ml/min (519.7 ml/min; p = 0.001). Compared with the control group, the thrombosis rate was 0.027 versus 0.148 episodes/patient-year (p = 0.009) and the total access-related cost was EUR 22,293 versus 47,467 (p = 0.033).
  
  
  CONCLUSIONS
  This study suggests that a combined monitoring program based on Kt and BTM-Qa represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments.
authors.affiliation: Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Néstor
authors.initials: N
authors.lastname: Fontseré
authors.forename: Gaspar
authors.initials: G
authors.lastname: Mestres
authors.forename: Marta
authors.initials: M
authors.lastname: Burrel
authors.forename: Marta
authors.initials: M
authors.lastname: Barrufet
authors.forename: Xavier
authors.initials: X
authors.lastname: Montaña
authors.forename: Marta
authors.initials: M
authors.lastname: Arias
authors.forename: Raquel
authors.initials: R
authors.lastname: Ojeda
authors.forename: Francisco
authors.initials: F
authors.lastname: Maduell
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000150:complications*; D001783:Blood Flow Velocity; D001831:Body Temperature; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D013815:Thermodilution / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control