Document Detail


Native arteriovenous fistula blood flow and resistance during hemodialysis.
MedLine Citation:
PMID:  12500230     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Measurement of vascular access flow (Qa) has been proposed as the ideal method for surveillance of native fistulae. However, debate exists about the influence of blood pressure (mean arterial pressure [MAP]) on Qa during dialysis. METHODS: During three consecutive dialysis treatments, 10 patients had paired measurements of Qa and MAP performed at 30, 60, 120, 180, 210, and 240 minutes. Access resistance (AR; in peripheral resistance units, PRUs) was calculated from MAP and Qa values. RESULTS: Overall pooled coefficients of variation (CVs) for MAP, Qa, and AR were 8.4%, 12.3%, and 12.9%, respectively. A significant reduction in Qa and MAP occurred throughout the dialysis treatment (Qa, 104 mL/min; P = 0.008; MAP, 10.4 mm Hg; P = 0.007). Mean percentages of change in Qa for the first third compared with the middle and last thirds of the session were -4.6% +/- 11.15% (SD) and -9.6% +/- 10.5%, respectively. Thus, Qa varied between 11.4% and -30.6% from baseline during the last hour of dialysis treatments. A stronger correlation between MAP and Qa was seen in radiocephalic (r2 = 0.55; P < 0.0001) compared with brachiocephalic fistulae (r2 = 0.06; P = 0.023). Mean AR was unchanged during the dialysis session (0.23 PRU; P = 0.358). AR for radiocephalic fistulae was significantly greater compared with brachiocephalic fistulae (6.03 +/- 3.90 versus 3.00 +/- 1.11 PRU; P < 0.0001). CONCLUSION: Qa could decrease up to 30% from baseline, potentially impairing the ability of Qa to predict impending vascular access failure. AR remained stable during the treatment and may be a more useful measure of vascular access performance as part of an access surveillance program.
Authors:
Kevan R Polkinghorne; Robert C Atkins; Peter G Kerr
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  41     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2002-12-24     Completed Date:  2003-01-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  132-9     Citation Subset:  IM    
Copyright Information:
Copyright 2003 by the National Kidney Foundation, Inc.
Affiliation:
Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia. kevan.polkinghorne@med.monash.edu.au
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MeSH Terms
Descriptor/Qualifier:
Arm / blood supply
Arteriovenous Fistula / metabolism*
Arteriovenous Shunt, Surgical / methods
Blood Pressure / physiology
Blood Pressure Determination / methods,  statistics & numerical data
Blood Volume Determination / methods,  statistics & numerical data
Brachial Artery / physiopathology,  surgery
Female
Forearm / blood supply
Humans
Male
Middle Aged
Prospective Studies
Radial Artery / physiopathology*,  surgery
Regional Blood Flow / physiology*
Renal Dialysis / methods*
Saphenous Vein / physiopathology,  surgery
Time Factors
Vascular Resistance / physiology*
Comments/Corrections
Comment In:
Am J Kidney Dis. 2003 Sep;42(3):614; author reply 614-5   [PMID:  12955696 ]

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


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