Early access flow rate predicts vascular access patency-related intervention in the first year: A retrospective cohort study

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2024-03-27 DOI:10.1111/hdi.13148

Matthias Bergmann, Butros Fakhoury, Tiago Barroso, Scott G. Prushik, Bertrand L. Jaber, Vaidyanathapuram S. Balakrishnan

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引用次数: 0

Abstract

Introduction

Arteriovenous fistulas and grafts are lifelines for most hemodialysis patients, and a low access flow rate often requires patency-related intervention, such as angioplasty or thrombectomy, to prevent access failure. We examined whether early access flow rate, measured after initial fistula/graft cannulation, predicts vascular access patency-related intervention within 1 year.

Methods

This was a single-center retrospective cohort study. Among 172 patients undergoing surgical creation of a fistula/graft, 52 (30.2%) had documented access flow rates measurement by the Transonic™ ultrasound dilution technique, performed within an average of 48 days from initial access cannulation. The need for a patency-related intervention, defined as undergoing a fistulogram, angioplasty, thrombectomy, or surgical revision, was ascertained within 1 year. A receiver-operating characteristic curve (ROC) was generated to evaluate the diagnostic performance of first and average access flow rates for predicting patency-related intervention within 1 year.

Findings

Twenty-eight (53.8%) of the 52 study subjects required a patency-related intervention within 1 year. Their characteristics were not significantly different from those who did not require patency-related interventions. However, first access flow rates were significantly lower in patients requiring patency-related intervention compared to those who did not (898 vs. 1471 mL/min; p = 0.003), as were average access flow rates (841 vs. 1506 mL/min; p < 0.001). The ROC analyses revealed that first access flow rates and average access flow rates predicted the need for patency-related intervention within 1 year, with an area under-the-ROC curve of 0.743 (95% confidence interval [CI] 0.608, 0.877) and 0.775 (95% CI 0.648, 0.903), respectively, demonstrating acceptable discrimination.

Discussion

In adults undergoing hemodialysis, early access flow rate measurement can predict patency-related intervention within 1 year after initial vascular access cannulation. Additional studies are required to confirm these findings and identify optimal access flow rate cut-off values to predict vascular accesses at higher risk of stenosis.

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早期通路流速可预测第一年与血管通路通畅相关的干预：一项回顾性队列研究。

导言：动静脉内瘘和移植物是大多数血液透析患者的生命线，如果通路流速较低，通常需要进行血管成形术或血栓切除术等与通路通畅相关的干预，以防止通路失效。我们研究了首次瘘管/移植物插管后测量的早期通路流速是否能预测 1 年内与血管通路通畅相关的干预措施：这是一项单中心回顾性队列研究。在 172 名接受瘘管/移植物手术的患者中，有 52 人（30.2%）在首次插入通路插管后平均 48 天内使用 Transonic™ 超声稀释技术测量了有记录的通路流速。在 1 年内确定是否需要进行与通畅相关的干预，即进行瘘管造影、血管成形术、血栓切除术或手术翻修。研究人员绘制了接收者操作特征曲线（ROC），以评估首次和平均通路流速在预测 1 年内通畅相关介入治疗方面的诊断性能：52名研究对象中有28人（53.8%）需要在1年内进行与通畅相关的干预。他们的特征与不需要通畅相关干预的人没有明显差异。但是，与不需要通畅相关干预的患者相比，需要通畅相关干预的患者的首次通畅率明显较低（898 对 1471 毫升/分钟；P = 0.003），平均通畅率也明显较低（841 对 1506 毫升/分钟；P 讨论：在接受血液透析的成人中，早期通路流速测量可预测首次血管通路插管后 1 年内与通畅相关的干预。还需要更多的研究来证实这些发现，并确定最佳通路流速截断值，以预测狭窄风险较高的血管通路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.