Standardized Dynamic Venous Pressure as Predictor of High Flow Dialysis Arterio-Venous Fistula
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- Category: Vol. 85, June 2017
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Standardized Dynamic Venous Pressure as Predictor of High Flow Dialysis Arterio-Venous Fistula, TAMER W. EL-SAID, HEBA W. EL-SAID, MOHAMED RIZK, MOHAMED HUSSEIN and HALA M. ALI
Abstract
Background: High intra access pressure may be regarded as a surrogate for Arteriovenous Fistula (AVF) outflow stenosis.
Methods: A cross sectional study was conducted on 30 chronic hemodialysis patients at Ain Shams University Hos-pital. Standardized dVP of studied patients AVF was measured. All measures were obtained from Gambro hemodialysis machine-model AK95, fistula needle gauge 16", and dialysis machine pump speed set at 200ml/min for 5 minutes. AVF Qa was obtained by means of color Doppler ultrasound using Mindray-M5 ultrasound system.
Results: The study included 20 males and 10 females with mean age 48±12.7. Sixteen subjects had radiocephalic, while 10 had bracheocephalic, and 4 had bracheobasilic AVFs. Mean values for standardized dVP and Qa, were 89.03±20.43 and 1128.93±781.21 respectively. There was a significant correlation between standardized dVP and AVF Qa (r=0.47 and p=0.008). Linear regression established that standardized dVP could statistically significantly predict AVF blood flow, F (1, 28)=8.074, p<.008 and dVP accounted for 22.4% of the explained variability in AVF blood flow. The regression equation was: Predicted Qa=–481.244+18.085 X (dVP). Of the AVFs studied, 23.3% (7/30) had high flow (Qa >2000ml/ min). ROC curve analysis was performed to determine the cut-off value for standardized dVP associated with high Qa AVFs which was 105mmHg (AUC 0.77, sensitivity 57.1%, specificity 91.3%).
Conclusion: High flow AV fistulae (Qa >2000ml/min) were associated with standardized dVP >105mmHg. Screening for standardized dVP may prompt definitive fistula flow assessment using color Doppler ultrasound allowing for early detection and management of high flow AVF.