Abstract: SA-PO1084
Assessment of Arteriovenous Fistula Maturation Using Central-Venous Oxygen Saturation and Estimated Upper-Body Blood Flow
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Rosales, Laura, Renal Research Institute, New York, New York, United States
- Zhang, Hanjie, Renal Research Institute, New York, New York, United States
- Chan, Brenda Kim, Renal Research Institute, New York, New York, United States
- Mateo, Marilou, Renal Research Institute, New York, New York, United States
- Johnson, Seth, Renal Research Institute, New York, New York, United States
- Thijssen, Stephan, Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background
Arterio-venous fistula (AVF) is the optimal vascular access in most hemodialysis (HD) patients. However, AVF maturation is difficult to assess. Central-venous oxygen saturation (ScvO2) and upper-body blood flow (UBBF) increase during AVF maturation. We followed AVF maturation using ScvO2 and estimated UBBF (eUBBF).
Methods
We studied 19 patients from an ongoing AVF quality improvement project. ScvO2 and hematocrit were measured with Crit-Line (FMC, Waltham, MA) between minutes 5 and 20 into HD, and eUBBF was computed as recently described (Rosales, Blood Purif, 2019).
Results
Following AVF creation, ScvO2 and eUBBF increased in 9 patients with unassisted AVF maturation and in 4 un-cannulated patients with good clinical AVF function (1 transplanted, 1 transferred, 2 awaiting cannulation) (Table 1). These indicators increased less in 5 patients requiring assisted AVF maturation and in one patient who succumbed to sudden cardiac death with a clinically matured AVF.
Conclusion
Our preliminary results indicate that ScvO2 and eUBBF provide point-of-care bio-signals that report AVF maturation and hemodynamic adaptation to the AVF. Advantages of this method are low costs, operator-independence, and scalability.
ScvO2 and eUBBF before and after AVF creation.
| Before AVF creation | Week 1 after AVF creation | Change between week 1 and pre AVF creation [%] | Week 4 after AVF creation | Change between week 4 and pre AVF creation [%] | ||||||
| ScvO2 [%] | eUBBF [L/min] | ScvO2 [%] | eUBBF [L/min] | ScvO2 | eUBBF | ScvO2 [%] | eUBBF [L/min] | ScvO2 | eUBBF | |
| Successful unassisted maturation and CV adaptation (N= 9) | 62.8 [60.5;63.5] | 1.5 [1.2; 1.5] | 76.4 [72.3;77.8] | 2.8 [1.9; 3.0] | 19.5 [15.9; 27.4] | 75.0 [54.8; 87.1] | 76.0 [74.6;80.9] | 2.0 [1.9;3.1] | 22.6 [15.4; 25.9] | 57.7 [32.0;138.5] |
| "Clinical" maturation and CV adaptation (N=4) | 61.9 [56.3;66.8] | 1.1 [0.9; 1.3] | 72.9 [69.5;74.7] | 1.9 [1.3; 2.0] | 9.7 [3.6; 30.4] | 47.9 [6.9; 108.4] | 66.2 [65.6;77.9] | 1.5 [1.3;2.4] | 19.9 [-2.1; 36.0] | 57.7 [10.0;160.5] |
| Assisted maturation and CV adaptation (N=5) | 62.2 [62.2;64.9] | 1.2 [1.0; 1.3] | 72.3 [70.7;74.0] | 1.5 [1.4; 1.9] | 13.9 [13.6; 16.2] | 39.5 [32.3; 45.1] | 71.2 [66.9;73.5] | 1.7 [1.3;1.7] | 9.6 [1.7; 44.2] | 26.1 [21.3;41.8] |
| Failed CV adaptation (N=1) | 71.2 | 2.3 | 76.9 | 3.0 | 8.0 | 27.6 | 72.6 | 1.8 | 2.0 | -23.8 |
Values represent median, 25th and 75th percentiles. CV, cardiovascular; ScvO2, central-venous oxygen saturation; eUBBF, estimated upper-body blood flow.