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Venous pressure monitoring does not accurately predict access failure in children
Deepa H Chand1, Stacy A Poe, C Frederic Strife
1Division of Pediatric Nephrology and Hypertension, A 120, The Cleveland Clinic Foundation, OH 44195, USA. chandd@ccf.org
Insights
Dynamic venous pressure monitoring does not adequately predict arteriovenous (AV) fistula or graft thrombosis in pediatric hemodialysis patients. This surveillance method is unreliable for detecting early signs of vascular thrombosis in children undergoing dialysis.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Vascular Access
Background:
- Access failure is a major cause of morbidity and mortality in hemodialysis patients.
- Routine monitoring of arteriovenous (AV) fistulas and grafts can improve access longevity.
- Dynamic venous pressure monitoring is a surveillance technique to detect early vascular thrombosis.
Purpose of the Study:
- To evaluate the effectiveness of dynamic venous pressure monitoring in predicting AV fistula and graft thrombosis in pediatric hemodialysis patients.
- To determine if venous pressure measurements correlate with thrombotic events in children.
Main Methods:
- Retrospective review of venous pressure measurements from pediatric patients undergoing hemodialysis with AV fistulas or grafts.
- Establishment of baseline venous pressures and comparison with pressures preceding thrombotic events.
- Statistical analysis using paired t-tests to assess correlation between venous pressures and thrombosis.
Main Results:
- A total of 335 venous pressure measurements were collected from ten pediatric patients.
- Eighteen thrombotic events occurred in five patients.
- Venous pressures did not show a significant correlation with thrombotic events (P=0.4284) or patient-specific thrombotic events (P=0.3229).
Conclusions:
- Dynamic venous pressure monitoring is not an adequate predictor of access thrombosis in pediatric hemodialysis patients.
- Current surveillance methods may need re-evaluation for pediatric populations.
- Further research is needed to identify reliable methods for early detection of thrombosis in pediatric vascular access.
Abstract:
Access failure is a significant cause of morbidity and mortality in hemodialysis patients. Routine monitoring of arteriovenous (AV) fistulas and grafts could increase access longevity. Dynamic venous pressure monitoring is a surveillance test advocated to detect early signs of vascular thrombosis. Venous pressure measurements obtained, per DOQI recommendations, in children undergoing hemodialysis with an AV fistula or graft were reviewed. Baseline venous pressures were established by calculating the mean of venous pressures obtained without an antecedent thrombosis. A paired t-test was performed comparing mean baseline pressure measurements with pressures immediately preceding each thrombosis episode. Since some patients had multiple thrombosis episodes, the assumption of independence was not met. A second paired t-test was performed comparing mean baseline pressures with the mean pressure measurement per individual, obtained immediately preceding a thrombosis episode; 335 venous pressures were collected in ten pediatric patients. Eighteen thromboses occurred in five patients, in whom a total of 241 venous pressures were measured. Venous pressures did not correlate with thrombotic events ( P=0.4284). Specific thrombotic events for each patient were correlated with mean patient-specific venous pressures and showed no correlation ( P=0.3229). Dynamic venous pressure monitoring is not an adequate predictor of access thrombosis in pediatric patients.