| Relationship between vascular access flow and hemodynamically significant stenoses in arteriovenous grafts. | |
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MedLine Citation:
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PMID: 19379339 Owner: NLM Status: PubMed-not-MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Vascular access dysfunction is a major source of hemodialysis patient morbidity. The NKF K/DOQI Guidelines promote access flow monitoring as the most preferred access surveillance method and have established access flow thresholds for fistulography: an absolute threshold of 600 ml/min and a dynamic threshold of flow less than 1000 ml/min that has decreased by more than 25% over 4 months. The Guidelines apply universally to accesses of different types, sizes, locations, and initial flow rates. METHODS: This article studies the application of access flow guidelines with human experimental data, animal experimental data, and a mathematical model of the arteriovenous graft system. RESULTS AND CONCLUSIONS: Analysis of experimental data and the mathematical model shows that a 20 to 30% and greater decrease in graft flow generally suggests the appearance of hemodynamically significant stenosis as defined by flow criteria. The model suggests that not all 50 to 60% stenoses may be hemodynamically significant or the most flow limiting. The mathematical model also suggests that positive predictive value of access surveillance may be increased for high-flow upper arm grafts by increasing the dynamic K/DOQI threshold from 1000 ml/min to 1200 ml/min. |
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Authors:
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Nikolai M Krivitski; Swaroop Gantela |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Hemodialysis international. International Symposium on Home Hemodialysis Volume: 7 ISSN: 1492-7535 ISO Abbreviation: Hemodial Int Publication Date: 2003 Jan |
Date Detail:
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Created Date: 2009-04-21 Completed Date: 2009-12-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101093910 Medline TA: Hemodial Int Country: Canada |
Other Details:
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Languages: eng Pagination: 23-7 Citation Subset: - |
Affiliation:
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Transonic Systems, Inc., Ithaca, New York, U.S.A. nikolai.krivitski@transonic.com |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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