Document Detail


Accuracy of physical examination and intra-access pressure in the detection of stenosis in hemodialysis arteriovenous fistula.
MedLine Citation:
PMID:  18248519     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Both physical examination (PE) and intra-access pressure (IAP) measurements have been used in the identification of stenosis in an arteriovenous access. The aim of this study was to evaluate the accuracy of PE and IAP in the diagnosis of arteriovenous fistula (AVF) stenosis. A total of 84 patients were enrolled in the study (54% men, mean age of 50.7 +/- 12.7 years and mean AVF patency of 24.9 +/- 7.8 months, 52% radiocephalic). Abnormalities of pulse and thrill were used as the diagnostic tools for the detection of stenosis using the physical examination. For IAP, stenosis was suspected when the ratio between IAP at the arterial puncture site and the mean blood pressure was <0.13 or >0.43. The diagnosis of stenosis was confirmed by Doppler ultrasound (DU). Sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (PNV), and accuracy were calculated for the two early detection tests. According to DU, 50 (59%) AVF were considered positive for the presence of stenosis. Fifty-six (66%) AVF were considered positive for the presence of stenosis by PE and 34 (40%) by IAP. S, SP, PPV, and NPV for PE and IAP were 96%, 76%, 86%, and 93% and 60%, 88%, 88%, and 60%, respectively. The accuracy for PE and IAP was 88% and 71%, respectively. PE proved to be an accurate method for the diagnosis of stenosis and should be part of all surveillance protocols of stenosis detection in AVF.
Authors:
Rodrigo Peixoto Campos; Domingos Candiota Chula; Sonia Perreto; Miguel Carlos Riella; Marcelo Mazza do Nascimento
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-02-01
Journal Detail:
Title:  Seminars in dialysis     Volume:  21     ISSN:  0894-0959     ISO Abbreviation:  Semin Dial     Publication Date:    2008 May-Jun
Date Detail:
Created Date:  2008-06-06     Completed Date:  2008-10-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  269-73     Citation Subset:  IM    
Affiliation:
Division of Interventional and Critical Care Nephrology, Hospital Universitário Evangélico de Curitiba, Curitiba, Brazil. rodrigopcampos@uol.com.br
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MeSH Terms
Descriptor/Qualifier:
Adult
Arteriovenous Shunt, Surgical / adverse effects*
Blood Pressure Determination
Confidence Intervals
Constriction, Pathologic / diagnosis
Female
Humans
Kidney Failure, Chronic / therapy
Male
Middle Aged
Physical Examination*
Predictive Value of Tests
Renal Dialysis
Reproducibility of Results

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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