Vascular Access Flow during Dialysis: Does Needle Orientation Matter?

Kidney and dialysis Pub Date : 2021-11-30 DOI:10.3390/kidneydial1020017

G. Tsangalis, Valérie Loizon

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Abstract

Background: Monitoring of vascular access outflow (VAO) in dialysis is based on the indicator dilution method by ultrasound (UD). The role of arterial needle orientation in VAO measurement is not clear. We compared the impact of the retrograde (RET) versus the antegrade orientation (ANT) in terms of (a) VAO (UD) and (b) dialysis adequacy. Moreover, we compared VAO (UD ANT and RET orientation) with VAO measured by Doppler ultrasound. Methods: 22 patients participated in the study. Inclusion criteria: Dialysis > 6 months with a functioning AVF, no stenosis, no active infection, EF > 45% and informed consent. 4 flow measurements were taken on the same dialysis day (4 consecutive weeks). To account for blood pressure variation, we “corrected” VAO for a mean arterial pressure of 100 mmHg. Doppler VAO was measured just before dialysis. Means were compared by the paired t-test. For correlation and agreement, linear regression and Bland-Altman analysis were performed respectively. Results: Mean VAO (UD) was higher in the (ANT) versus the (RET) orientation: 1286.17 mL/min (SD = 455.78, 95%CI = 1084–1488) versus 1189.96 mL/min (SD = 401.05, 95%CI = 1012–1368) (p = 0.013) with a mean difference of 96.21 mL/min (5.66%). Mean Kt/V (RET orientation) was 1.57 (SD = 0.10, 95%CI = 1.52–1.61) versus 1,55 (SD = 0.10, 95%CI = 1.50–1.60) (ANT) orientation (p = 0.062). Recirculation was always 0%. The mean VAO (Doppler) was 1079.54 mL/min (SD = 356.04, 95%CI = 922–1237), 16% lower than VAO measured by UD with (ANT) orientation (p = 0.009) and 9.3% lower than the VAO in the (RET) orientation (p = 0.113). Linear regression analysis showed that VA flows (ANT versus RET) orientation of the needle correlates well between them (r = 0.93, p < 0.001) but show poor agreement (Bland–Altman analysis). Conclusion: VAO (UD) in the RET orientation was significantly lower than VAO in the ANT orientation and more consistent with VAO assessed by Doppler without influencing dialysis adequacy. Therefore, when using UD for VAO surveillance, the RET orientation should be used.

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透析期间血管通路流动:针的方向有影响吗?

背景：透析中血管通路流出（VAO）的监测是基于超声指示剂稀释法（UD）。动脉针方向在VAO测量中的作用尚不清楚。我们比较了逆行（RET）与顺行定向（ANT）在（a）VAO（UD）和（b）透析充分性方面的影响。此外，我们将VAO（UD-ANT和RET方位）与多普勒超声测量的VAO进行了比较。方法：22例患者参与本研究。纳入标准：透析>6个月，AVF功能正常，无狭窄，无活动性感染，EF>45%，知情同意。在同一透析日（连续4周）进行4次流量测量。为了解释血压变化，我们将VAO“校正”为平均动脉压100毫米汞柱。在透析前测量多普勒VAO。平均值通过配对t检验进行比较。对于相关性和一致性，分别进行了线性回归和Bland-Altman分析。结果：（ANT）方向与（RET）方向的平均VAO（UD）更高：1286.17 mL/min（SD=455.78，95%CI=1084–1488）与1189.96 mL/min（SD=401.05，95%CI=1012–1368）（p=0.013），平均差异为96.21 mL/min（5.66%）。平均Kt/V（RET方向）为1.57（SD=0.10，95%CI=1.52–1.61）与1.55（SD=.10，95%CI=1.50–1.60）（ANT方向）（p=0.062）。再循环始终为0%。平均VAO（多普勒）为1079.54 mL/min（SD=356.04，95%CI=922–1237），在（ANT）方向上比UD测量的VAO低16%（p=0.009），在（RET）方向下比VAO低9.3%（p=0.113）。线性回归分析表明，VA流量（ANT与RET）针的方向之间相关性良好（r=0.93，p<0.001），但一致性较差（Bland–Altman分析）。结论：RET方向的VAO（UD）显著低于ANT方向的VAO，并且与多普勒评估的VAO更一致，而不影响透析的充分性。因此，当使用UD进行VAO监测时，应使用RET方向。

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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Kidney and dialysis

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