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Related Experiment Videos

Intradialytic serial vascular access flow measurements.

S U Rehman1, L B Pupim, Y Shyr

  • 1Divisions of Nephrology and Biostatistics, Vanderbilt Univeristy Medical Center, Nashville, TN USA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 2, 1999
PubMed
Summary

Vascular access blood flow (VABF) in chronic hemodialysis patients tends to decrease during treatment, particularly as mean arterial blood pressure (MAP) drops. Monitor VABF early in dialysis or when MAP is stable for accuracy.

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Cardiovascular Physiology

Background:

  • Vascular access failure is a significant complication for chronic hemodialysis (CHD) patients.
  • Serial vascular access blood flow (VABF) measurements are increasingly used for screening.
  • Limited data exist on VABF changes during hemodialysis sessions, potentially impacting measurement validity.

Purpose of the Study:

  • To evaluate the trend of VABF during hemodialysis sessions.
  • To identify factors influencing VABF changes during treatment.
  • To assess the optimal timing for VABF measurements in CHD patients.

Main Methods:

  • Thirty-two CHD patients underwent serial VABF measurements at 30, 90, and 150 minutes.
  • Mean arterial blood pressure (MAP), ultrafiltration rate, and patient symptoms were recorded concurrently.

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  • Multivariate analysis was used to determine predictors of VABF changes.

    • Main Results:

    • Mean VABF showed a statistically significant decrease from 1,344 mL/min at 30 minutes to 1,250 mL/min at 150 minutes (P = 0.03).
    • A strong correlation was observed between VABF and MAP, especially after 90 minutes (r = 0.68; P < 0.001).
    • Each 10% decrease in MAP after 90 minutes predicted an 8% decrease in VABF; ultrafiltration and access type did not significantly affect VABF changes.

    Conclusions:

    • VABF measurements are generally reliable up to 2 to 2.5 hours into hemodialysis.
    • Mean arterial blood pressure (MAP) is the primary determinant of VABF fluctuations during dialysis.
    • For patients experiencing significant MAP decrease (>15%), VABF measurement within the first 90 minutes or during a session with stable MAP is recommended.