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Kidney Week

Abstract: TH-PO336

The Use of Doppler Ultrasound in Hemodialysis Patients for Vascular Access Surveillance: Arguing the Revised Hemodialysis Vascular Access Guidelines

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Spanos, Georgios, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
  • Fragkidis, Stylianos, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
  • Giannikouris, Ioannis Emmanouel, Medifil SA Private Hemodialysis Center, Athens, ATTIKA, Greece
  • Bantis, Christos, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
  • Paschou, Styliani, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
  • Bamichas, Gerasimos Ioannis, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece
Background

The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for the management of vascular access (VA) in hemodialysis (HD) is currently in external review process. Only clinical monitoring is being clearly suggested for VA surveillance. Our experience implies a promising role for the use of diagnostic methods like Doppler ultrasound (US) in daily practice. The aim of this study is to explore the use of Doppler US audit in HD patients with arteriovenous fistulas (AVF) and grafts (AVG), performed by nephrologists.

Methods

This is a single centre study with prospective evaluation of AVF or AVG in stable HD patients. Patients’ VA was assessed by the same nephrologist with the use of a color Doppler US in a twelve-month monitoring period. Basic VA anatomical and functional parameters like mean volume flow (MVF) and percentage of change in mean volume flow (ΔMVF), stenosis and other abnormalities were recorded. Demographic and clinical characteristics were assessed, while cumulative secondary survival (CSS) and secondary patency rate (SPR) along with abnormality rates were calculated and further analysed.

Results

A total of 43 patients (30 male), 21% diabetic, age 61.5±13 years, enrolled in the study. 76.7% of patients had an AVF while 23.3% had an AVG. At baseline, 18.6% of patients had a MVF<600 ml/min, while 18.3% appeared to have significant stenosis in the access circuit. ΔMVF was categorized as stable or reduced in the event of a change in mean VF>30%. At the end of the study, SPR for all VA was 76.74%, (81.82% for AVF and 40% for AVG). Cumulative secondary survival was 65±26 months for the above study population, and when comparing AVF and AVG, CSS was 78.61±24 months and 21.80±13 months respectively (p=0.001). In univariate analysis, age, the presence of diabetes, ΔMVF, and the presence of stenosis were correlated with CSS. In a multivariate model only age and the presence of stenosis in the access circuit retained correlation with CSS.

Conclusion

In a hemodialysis unit where VA assessment with an US by nephrologist is available, frequent audit seems to offer an additional benefit for patients’ VA survival to clinical surveillance.