title: Arteriovenous access monitoring with ultrasound dilution in a pediatric hemodialysis unit.
abstract: BACKGROUND
  Permanent arteriovenous (AV) access is the preferred access for dialysis delivery in children and adolescents requiring chronic hemodialysis (HD). Ultrasound dilution (UD) monitoring of AV access flow is widely used in adult HD units for the early detection of stenosis but experience in pediatrics is limited.
  
  
  METHODS
  We monitored all maintenance HD patients with AV access using a noninvasive screening algorithm based on UD access flow. We assessed the effectiveness of this algorithm by comparing it to fistulagrams and its impact on AV access-related morbidity.
  
  
  RESULTS
  AV access thrombosis rates fell from 13.5 per 100 patient-months on HD during the baseline period to 3.5 per 100 patient-months on HD during the screening period (p < 0.04). The mean blood flow rate by UD measurement was lower in AV accesses that went on to thrombose compared to those without thrombosis (1,203 ml/min/1.73 m(2) vs. 1,683 ml/min/1.73 m(2), p < 0.001). When compared to fistulagrams, the screening algorithm was 94% sensitive and 77% specific in detecting hemodynamically significant stenosis, with positive and negative predictive values of 83 and 91% respectively.
  
  
  CONCLUSIONS
  A noninvasive UD screening algorithm of AV access flow is very sensitive in detecting hemodynamically significant stenosis and can decrease AV access thrombosis rates.
authors: Boston Children's Hospital, Boston, Mass., USA.
authors: Isa F
authors: IF
authors: Ashoor
authors: Elizabeth A
authors: EA
authors: Hughson
authors: Michael J G
authors: MJ
authors: Somers
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D000069453:Ultrasonic Waves; D014463:Ultrasonography; D055815:Young Adult