Dialysis therapiesFlow monitoring: performance characteristics of ultrasound dilution versus color Doppler ultrasound compared with fistulography
Section snippets
Study design and patients
A prospective, observational intervention study was conducted in the hemodialysis centers of the University of Vienna Medical School, Vienna, Austria. Only patients with a native forearm AV fistula as primary dialysis access were considered. Sixty-six of 69 patients in these units with a native forearm fistula were enrolled into the study. Seven patients did not complete the study because of withdrawal of signed consent (n = 4), transplantation (n = 2), or transfer to another dialysis center (n
Patient characteristics
A diagnosis of access stenosis was made by fistulography in 41 of 59 patients. The distribution of important covariates for access patency, such as patient age, sex, diabetic status, hematocrit, and previous implants of permanent catheters of previous PTAs, were equally distributed between the 2 groups. Patient demographic characteristics according to vascular access patency are listed in Table 1.
Performance characteristics of the 2 ultrasound techniques compared with fistulography
Calculation of the ROC showed an area under the curve (AUC) of 0.79 (95% CI, 0.66 to 0.91) for UDT
Discussion
Our prospective study evaluated characteristics of the 2 most widely used ultrasound techniques for the prediction of access stenoses. The UDT and CDUS performed equally, with slight advantages of the UDT in the low sensitivity range. Few studies have correlated ultrasound blood flow measurement with angiographic findings in hemodialysis patients. However, negative likelihood ratios could not be calculated in these reports, with the exception of the study by Gadallah et al,14 because
Acknowledgements
The authors acknowledge the support of the nursing stuff of the hemodialysis unit for their help in patient administration.
References (23)
- et al.
Are hemodialysis access flow measurements by ultrasound dilution the standard of care for access surveillance?
Adv Ren Replace Ther
(2002) - et al.
The role of color flow Doppler ultrasound in dialysis access
Semin Nephrol
(2002) - et al.
Graft surveillanceVenous pressure, access flow, or the combination?
Kidney Int
(2001) Theory and validation of access flow measurement by dilution technique during hemodialysis
Kidney Int
(1995)- et al.
Accuracy of duplex scanning for measurement of arterial volume flow
J Vasc Surg
(1992) - et al.
Reporting standards for percutaneous interventions in dialysis accessTechnology Assessment Committee
J Vasc Interv Radiol
(1999) - et al.
Accuracy of Doppler ultrasound in diagnosing anatomic stenosis of hemodialysis arteriovenous access as compared with fistulography
Am J Kidney Dis
(1998) - et al.
Predictive measures of vascular access thrombosisA prospective study
Kidney Int
(1997) - et al.
Analysis of variable flow Doppler hemodialysis access flow measurements and comparison with ultrasound dilution
Am J Kidney Dis
(2001) - et al.
Outcome and prognostic factors of restenosis after percutaneous treatment of native hemodialysis fistulas
J Vasc Interv Radiol
(2002)
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Supported in part by grant no. 1675 from the University of Vienna.