Static pressures, intra-access blood flow and dynamic Kt/V profiles in the prediction of dialysis access function

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英文篇名：Static pressures, intra-access blood flow and dynamic Kt/V profiles in the prediction of dialysis access function 作者：Abhilash ; Koratala ; Bhagwan ; Dass ; Kawther ; F ; Alquadan ; Simrun ; Sharma ; Girish ; Singhania ; Abutaleb ; A ; Ejaz 英文作者：Abhilash Koratala;Bhagwan Dass;Kawther F Alquadan;Simrun Sharma;Girish Singhania;Abutaleb A Ejaz;Division of Nephrology, Hypertension and Transplantation, University of Florida;Division of Nephrology and Hypertension, University of Utah; 英文关键词：Static;;Intra-access;;Pressures;;Hemodialysis;;Kt/V 中文刊名：SZXS 英文刊名：世界肾脏学杂志(英文版) 机构：Division of Nephrology, Hypertension and Transplantation, University of Florida;Division of Nephrology and Hypertension, University of Utah; 出版日期：2019-06-28 出版单位：World Journal of Nephrology 年：2019 期：v.8 基金：the Gatorade Trust through funds distributed by the University of Florida,Division of Nephrology,Hypertension,and Renal Transplantation,Gainesville,FL [Awarded to Abhilash Koratala(Principal investigator);Abutaleb A Ejaz(Mentor)] 语种：英文; 页：SZXS201903002 页数：8 CN：03 分类号：19-26

摘要

BACKGROUND Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were associated with abnormal Kt/V values, high access recirculation and deviation of the Kt/V profile(Abnormal Kt/V profile) from normally expected values(Normal Kt/V profile).AIM To hypothesize that static or derived access pressures would correlate with direct intra-access blood flow rates and that clearance(Kt/V) profiles would correlate with measured Kt/V values.METHODS Static access pressures, real-time adequacy of dialysis and intra-access blood flow were investigated in end stage renal disease patients undergoing hemodialysis.Wilcoxon-Mann-Whitney test, chi-square test or Fisher's exact test was used to investigate differences between the groups; Spearman's rank correlation test to investigate relationships between static pressures, direct intra-access pressures and Kt/V profiles; and multinomial logistic regression models to identify the independent effect of selected variables on Kt/V profiles. Odds ratio were calculated to measure the association between the variables and Kt/V profiles.RESULTS One hundred and seven patients were included for analysis. There were no significant differences between genders, and types of vascular access between the normal vs. abnormal clearance(Kt/V) profile groups. No significant correlation could be demonstrated between static access pressures and Kt/V profiles, static access pressures and intra-access blood flow, intra-access blood flow and Kt/V profiles, measured Kt/V and Kt/V profiles or recirculation and Kt/V profiles.CONCLUSION In this study utilizing measured versus estimated data, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. These parameters, though useful estimates, cannot be accepted as quality assurance for dialysis adequacy or access function without further evidences.
        BACKGROUND Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were associated with abnormal Kt/V values, high access recirculation and deviation of the Kt/V profile(Abnormal Kt/V profile) from normally expected values(Normal Kt/V profile).AIM To hypothesize that static or derived access pressures would correlate with direct intra-access blood flow rates and that clearance(Kt/V) profiles would correlate with measured Kt/V values.METHODS Static access pressures, real-time adequacy of dialysis and intra-access blood flow were investigated in end stage renal disease patients undergoing hemodialysis.Wilcoxon-Mann-Whitney test, chi-square test or Fisher's exact test was used to investigate differences between the groups; Spearman's rank correlation test to investigate relationships between static pressures, direct intra-access pressures and Kt/V profiles; and multinomial logistic regression models to identify the independent effect of selected variables on Kt/V profiles. Odds ratio were calculated to measure the association between the variables and Kt/V profiles.RESULTS One hundred and seven patients were included for analysis. There were no significant differences between genders, and types of vascular access between the normal vs. abnormal clearance(Kt/V) profile groups. No significant correlation could be demonstrated between static access pressures and Kt/V profiles, static access pressures and intra-access blood flow, intra-access blood flow and Kt/V profiles, measured Kt/V and Kt/V profiles or recirculation and Kt/V profiles.CONCLUSION In this study utilizing measured versus estimated data, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. These parameters, though useful estimates, cannot be accepted as quality assurance for dialysis adequacy or access function without further evidences.

引文

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