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Kidney Week

Abstract: TH-PO338

The Possibility of Ionic Dialysance as an Index to Predict the Dysfunction of Vascular Access

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

  • Kim, Haksoo, Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Soon Bae, Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  • Chang, Jai won, Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
Background

Vascular access dysfunction (VAD) in hemodialysis (HD) results in insufficient dialysis dose represented by low Kt/Vurea calculated using the serum levels of BUN. If Kt/Vurea declines by more than 0.2 without any specific cause, VAD accounts for 70% of the causes. However, the measurement of Kt/Vurea in every session of HD is very cumbersome in clinical practice. Ionic dialysance, Kt/VID calculated by on-line monitoring of conductivity, is easy, non-invasive, able to be measured in every session without cost. Although Kt/VID was not the same value as Kt/Vurea, it was highly correlated with Kt/Vurea. The aim of this study is to investigate whether Kt/VID, instead of Kt/Vurea, could be used as an index for the detection of VAD by analyzing the change of Kt/VID before and after intervention.

Methods

We conducted a retrospective study in 23 patients (M:F=13:10, median of age 71 (IQR 63~80) years, HD duration 80 (43~128) months, AVF:AVG=7:16, DM:non-DM=12:11) underwent 29 times of intervention for VAD between Jan 2017 and Apr 2018. We gathered demographic data and available Kt/VID in our subjects for 14 days just before and just after intervention by reviewing electronic medical records.

Results

The median age of vascular access was 48 (IQR 20~60) months in this study. The main intervention for VAD was percutaneous transluminal angioplasty (96.5%). Thrombectomy (10.3%) or the insertion of peripheral stent (6.9%) was combined, if needed. Although the change of arterial static intra-access pressure ratio (SIAPR) was not significant, venous SIAPR significantly decreased after intervention (0.613 ± 0.194 vs. 0.399 ± 0.159, p < 0.01). The intervention for VAD showed the significant increase in Kt/Vurea (1.66 ± 0.29 vs. 1.75 ± 0.28, p=0.044) and in Kt/VID (1.26 ± 0.30 vs. 1.31 ± 0.30, p=0.038).

Conclusion

Considering the significant increase of Kt/VID before and after intervention, the reduction of Kt/VID could be used as an index to require the intervention for VAD. In the future, the analysis of prospectively collected Kt/VID at every HD session is necessary to define the degree of decrement in Kt/VID to suggest critical VAD.