Measuring the adequacy of hemodialysis access

Current Opinion in Nephrology and Hypertension

Volumn 5, Issue 6, 1996, Pages 527-531

  Besarab, Anatole ^a   Samarapungavan, Dilip ^a  

^a HENRY FORD HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

FLOW; HEMODIALYSIS; HEMODYNAMICS; MEASUREMENT; MONITORING; MORBIDITY; PRIORITY JOURNAL; REVIEW; STENOSIS; THROMBOSIS;

ARTERIOVENOUS SHUNT, SURGICAL; CATHETERS, INDWELLING; GRAFT OCCLUSION, VASCULAR; HUMANS; KIDNEY FAILURE, CHRONIC; RENAL DIALYSIS; THROMBOSIS;

EID: 0030449461     PISSN: 10624821     EISSN: None     Source Type: Journal    
DOI: 10.1097/00041552-199611000-00013     Document Type: Review

References (57)

1. Kaufmann JL: The decline of the autogenous hemodialysis access site. Semin Dial 1995, 8:59-61.
2. US Renal Data System: USRDS 1995 Annual Data Report, X. The cost effectiveness of alternative types of vascular access and the economic cost of ESRD. Am J Kidney Dis 1995, 26(suppl 2):S140-S156.
3. Hood SA, Schillo B, Beane GE, Rozas V, Sondheimer JH, and members of Michigan Renal Task Force of the Michigan Public Health Institute: An analysis of the adequacy of preparation for end-stage renal disease care in Michigan. ASAIO J 1995, 41:M422-M426.
4. Anderson RC, DeBord JR: Tertiary vascular access surgery for chronic hemodialysis. Semin Dial 1995, 8:88-94.
5. Feldman HI, Kobrin S, Wasserstein A: Hemodialysis vascular access morbidity. J Am Soc Nephrol 1996, 7:523-535. This is an excellent review of the morbidity of vascular access in the USA. It provides an historical perspective, data on access-related admission to hospital and the economic burden of vascular access dysfunction. It evaluates the risk factors for dysfunction of both autologous fistulas and PBGs. There is a good discussion of the tradeoffs in choosing a particular access type.
6. Gupta AJ, Karak PK: Translumbar inferior vena cava catheter for long-term hemodialysis. J Am Soc Nephrol 1995, 5:2094-2097.
7. Lund GB, Trerotola SO, Scheel PJ: Percutaneous translumbar Inferior vena cava cannulation for hemodialysis. Am J Kidney Dis 1995, 25:732-737.
8. Duncan KA, Karlin CA, Beezley M: Percutaneous transhepatic PermCath for hemodialysis access [Letter]. Am J Kidney Dis 1995, 25:973.
9. Po CL, Koolpe HA, Allen S, Alvez LD, Raja RM: Transhepatic PermCath for hemodialysis. Am J Kidney Dis 1994, 24:590-591.
10. Culp K, Flanigan M, Taylor L, Rothstein M: Vascular access thrombosis in new hemodialysis patients. Am J Kidney Dis 1995, 26:341-346. This paper emphasizes the need to construct more primary autologous fistulas and to allow them to mature for more than 30 days before use. The relative risk of thrombosis is almost twice as high in PBGs as in autologous fistulas. There is a lower risk of thrombosis if blood flow rates are kept below 300 ml/min. Neither a heparin dose nor the use of erythropoietin is associated with the risk of thrombosis.
11. Rittgers SE, Garcia-Valdez C, McCormick JT, Posner MP: Non-invasive blood flow measurements in expanded polytetrafluroethylene grafts for hemodialysis accesses. J Vasc Surg 1986, 3:635-642.
12. Besarab A, Hall B, Al-Ajel F, Deane C, Zasuwa G: The relation of brachial artery flow to access flow [Abstract]. J Am Soc Nephrol 1995, 6:483.
13. Sands J, Young S, Miranda C: The effect of Doppler flow screening studies and elective revisions on dialysis access failure. ASAIO Journal 1992, 38:M524-M527.
14. Strauch BS, O'Connell RS: Permanent vascular access for hemodialysis: the role of color Doppler flow imaging in the assessment of the hemodialysis vascular access. Semin Dial 1995, 8:142-146. This is an excellent review of color Doppler flow imaging technology. Its sensitivity and specificity compared with angiography are high, but most series reflect patients selected for a high probability of access dysfunction. Data on access flow as a predictor of access thrombosis are provided.
15. Sands JJ, Miranda CL: Prolongation of hemodialysis access survival with elective revisions. Clin Nephrol 1995, 44:329-333. It is reported that prospective monitoring of vascular accesses from the time of placement and elective revision before first thrombosis reduces subsequent thrombosis and intervention rates by a factor of 2, and that elective revision of lesions in autologous fistulas prolongs longevity by > 600 days.
16. Besarab A, Ross R, Al-Ajel F, Deane C, Frinak S, Zasuwa G: The relation of intra-access pressure to flow [Abstract]. J Am Soc Nephrol 1995, 6:483.
17. Rekhter M, Nicholls S, Ferguson M, Gordon D: Cell proliferation in human arteriovenous fistulae used for hemodialysis. Arterioscler Thromb 1993, 13:609-617.
18. Sullivan KL, Besarab A, Dorrell, S, Moritz, MJ: The relationship between dialysis graft pressure and stenosis. Invest Radiol 1992, 27:352-355.
19. Sullivan KL, Besarab A, Bonn J, Shapiro MJ, Gardiner GA, Moritz MJ: Hemodynamics of falling dialysis grafts. Radiology 1993, 186:867-872.
20. Besarab A, Moritz M, Sullivan K, Dorrell S, Price JJ: Venous access pressures and the detection of intra-access stenosis. ASAIO J 1992, 38:M519-M523.
21. Beathard GA: Physical examination of AV grafts. Semin Dial 1992, 5:74-78.
22. Villemarette PA, Kornick AL, Rosenberg DM, Holmes J, Hower JF: Use of color-flow Doppler to evaluate vascular access graft function. J Vasc Technol 1989, 8:164-170.
23. Collins DM, Lambert MB, Middleton JP, Proctor RK, Davidson CJ, Newman GE, Schwab SJ: Fistula dysfunction: effect on rapid dialysis. Kidney Int 1992, 41:1292-1296.
24. Sherman RA, Levy SS: Assessment of a two-needle technique for the measurement of recirculation during dialysis. Am J Kidney Dis 1991, 18:80-83.
25. Hester RL, Ashcraft D, Curry E, Bower J: Non-Invasive determination of recirculation in the patient on dialysis. ASAIO J 1992, 38:M190-M193.
26. Lindsey RM, Burbank J, Brugger J, Bradfield E, Kram R, Malek P, Blake PG: A device and a method for the rapid and accurate measurement of access recirculation during hemodialysis. Kidney Int 1996, 49:1152-1160. This paper describes the measurement of access recirculation using a conductivity method which requires the use of a special blood tubing set. Only two out of 27 patients with autologous fistula and none out of 22 patients with a PBG had any recirculation (threshold for detection > 2%). The paper provides data on the dependence of access recirculation on blood pump flow rate.
27. Depner TA, Krivitsky NM, MacGibbon D: Hemodilaysis access recirculation measured by ultrasound dilution. ASAIO J 1995, 41:M749-M753. A new technique for measuring recirculation using the principle of ultrasound dilution is described. Replicability was excellent and the correlation with urea-based methods when access recirculation was induced by deliberate needle reversal was high. The ease of use of the technique and its accuracy may make such methods the 'gold-standards' for the future.
28. Santoro A: On-line monitoring. Nephrol Dial Transplant 1995, 10:615-618.
29. Daniels ID, Berlyne GM, Barth RH: Blood flow rate and access recirculation in hemodialysis. Int J Artif Organs 1992, 15:470-474.
30. Schneditz D, Kaufman A, Polaschegg H, Levin N, Dairgirdas J: Cardiopulmonary recirculation during hemodialysis. Kidney Int 1992, 42:1450-1456.
31. Sherman R: The regional blood flow model; a revisitation. Semin Dial 1995, 8:12-14.
32. Sombolos K, Natse T, Zoumbaridis N, Mavromatidis K, Karagianni A, Scandalos J, Fitili C: Urea concentration gradients during conventional hemodialysis. Am J Kidney Dis 1996, 27:673-679.
33. Van Stone JC: Peripheral venous blood is not the appropriate specimen to determine the amount of recirculation during hemodialysis. ASAIO J 1996, 42:41-45. This is an excellent paper which examines the disequilibrium between arterial and venous blood during hemodialysis and the rate of its dissipation when dialysis urea solute removal is stopped. It provides convincing data for avoiding the peripheral vein sample in measuring access recirculation.
34. Depner TA, Rizwan S, Cheer AY, Wagner JM, Eder LA: High venous urea concentrations in the opposite arm: a consequence of hemodialysis-induced compartment disequilibrium. ASAIO J 1991, 37:M141-M143.
35. Tattersall JE, Farrington K, Raniga PD, Thompson H, Tomlinson C, Aldridge C, Greenwood RN: Haemodialysis recirculation detected by the three-sample method is an artifact Nephrol Dial Transplant 1993, 8:60-63.
36. Buur T, Will EJ: Haemodialysis recirculation measured using a femoral artery sample. Nephrol Dial Transplant 1994, 9:395-396.
37. Besarab A, Ross R, Effendi A, Frinak S: The relation of recirculation (R) to access flow [Abstract] J Am Soc Nephrol 1995, 7:482.
38. Schwab SJ, Raymond FR, Saeed M, Newman GE, Dennis PA, Bollinger RR: Prevention of hemodialysis fistula thrombosis: early detection of venous stenosis. Kidney Int 1989, 36:707-711.
39. Besarab A, Al-Saghir F, Alnabhan N, Lubkowski T, Frinak S: Simplified measurement of intra-access pressure. ASAIO J 1996, 42:(in press).
40. Besarab A, Sullivan KL, Ross R, Moritz M: The utility of intra-access monitoring in detecting and correcting venous outlet stenoses prior to thrombosis. Kidney Int 1995, 47:1364-1373. This paper describes the methodology of intra-access pressure monitoring and the criteria for angioplasty referral. Stenoses having a 50% diameter narrowing should undergo elective angioplasty, because waiting for a greater degree of stenosis does not reduce the thrombosis rate. A reduction in the thrombosis rate reduces access replacement rates by 70% and increases the useful life of accesses by 1 year.
41. Kanterman RY, Vesely TM, Pilgram TK, Guy BW, Windus DW, Picus D: Dialysis access grafts: anatomic location of venous stenoses and results of angioplasty. Radiology 1995, 195:135-139.
42. Stikovak M, Talley JD: Use of intravascular Doppler velocimetry during angioplasty of falling hemodialysis shunts. J Ultrasound Med 1995, 14:211-215. This paper reports a prospective study showing good correlation between Doppler measurements and angiographic and pressure measurements in vascular accesses. It provides valuable data on changes in intra-access flow at different locations relative to the stenosis, the pressure gradient across the stenosis and the anatomical degree of luminal reduction before and after angioplasty. The techniques used should be adopted by interventionalists to assess 'the success' of their procedures.
43. Kaye M, Lemaitre P, O'Regan S: A new technique for measuring blood flow in polytetrafluroethylene grafts for hemodialysis. Clin Nephrol 1977, 6:533-534.
44. Greenwood RN, Aldridge C, Goldstein L: Assessment of arteriovenous fistulae from pressure and thermal dilution studies: clinical experience with forearm fistulae. Clin Nephrol 1985, 23:189-197.
45. Finlay DE, Longley DG, Foshager MC, Letoumeau JG: Duplex and color Doppler sonography of hemodialysis arteriovenous fistulae and grafts. Radiographics 1993, 13:983-989.
46. Oates CP, Williams ED, McHugh MI: The use of the Diasonics DRF-400 duplex ultrasound scanner to measure volume flow in arteriovenous fistulae in patients undergoing haemodialysis: an analysis of measurement uncertainties. Ultrasound Med Biol 1990, 16:571-579.
47. Berkoben MS, Schwab SJ: Permanent vascular access for hemodialysis: intravascular ultrasound imaging in the evaluation and treatment of hemodialysis fistula stenoses. Semin Dial 1995, 8:148-151. This is a review of the technology which allows evaluation of the stenotic lesion composition (hard versus soft plaque), its topography (eccentric versus concentric), detection of thrombus and mechanisms of successful angioplasty. The technique is currently still investigational.
48. Miranda CL, Sands JJ: Duplex referral of hemodialysis accesses for percutaneous balloon angioplasty. J Vasc Technol 1996, 20:(in press).
49. Tordoir JHM, Hoeneveld H, Eikelboom BC, Kitslaar PJEHM: The correlation between clinical and Doppler ultrasound parameters and the development of complications of arterio-venous fistulae for hemodialysis. Eur J Vasc Surg 1990, 4:179-184.
50. Strauch BS, O'Connell RS, Geoly KL: Forecasting thromboses of vascular access with Doppler color flow Imaging. Am J Kidney Dis 1992, 19:554-557.
51. Krivitsky NM: Theory and validation of access flow measurements by dilution technique during hemodialysis. Kidney Int 1995, 48:244-250.
52. Depner TA, Krivitsky NM: Clinical measurement of blood flow in hemodialysis access fistulae and grafts by ultrasound dilution. ASAIO J 1995, 41:M475-M479. A novel method of accurately assessing access blood flow 'on-line' using ultrasound velocity dilution principles is described. Such on-line flow measurement techniques after deliberate inducement of access recirculation during the period of measurements will become increasingly available. The accuracy is quite good using this technique. Sequential measurements will be the key to detecting stenoses before thrombosis.
53. Bakker CJ, Bosman PJ, Boereboom FT, Balnkenstijn PJ, Mali WP: Measuring flow in hemodialysis grafts by non-triggered 2DPC magnetic resonance angiography. Kidney Int 1996, 49:903-905. This paper describes an accurate way of measuring access flow. The major limitation to greater use of the method will be the accessibility of patients to this expensive technology.
54. Glanz S, Bashist B, Gordon DH, Butt KMH, Adamson R: Angiography of upper extremity access fistulas for dialysis. Radiology 1982, 143:45-52.
55. Jackson A, England REM: Investigation of the failing hemodialysis access: the role of intravenous digital subtraction angiography. Semin Dial 1995, 8:152-157.
56. Pagano D, Green MA, Henderson MJ, Kmiot WA, Goldman MD: Surveillance policy for early detection of failing arteriovenous fistulae for hemodialysis. Nephrol Dial Transplant 1994, 9:275-279.
57. Bücker A, Vorwerk D, Günther RW: Transbrachial fine-needle arteriography with special focus on hemodialysis shunt imagining. Nephrol Dial Transplant 1995, 10:838-841.