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Thresholds for significant decrease in hemodialysis access blood flow.

Sunanda J Ram1, Raja Nassar, Rashid Sharaf

  • 1Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.

Seminars in Dialysis
|January 10, 2006
PubMed
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Establishing statistically significant criteria for hemodialysis access surveillance is crucial. This study defines thresholds for blood flow (Q) decrease (deltaQ) to guide stenosis evaluation, recommending >33% for avoiding unnecessary procedures.

Area of Science:

  • Nephrology
  • Vascular Access
  • Medical Device Technology

Background:

  • Hemodialysis access surveillance relies on detecting significant blood flow (Q) decrease to identify stenosis.
  • Current criteria for statistically significant Q decrease are not well-established, leading to potential delays or unnecessary interventions.

Purpose of the Study:

  • To establish statistically significant criteria for determining a decrease in hemodialysis access blood flow (Q).
  • To define thresholds for percentage decrease in Q (deltaQ) for various p-values.

Main Methods:

  • Analyzed Q variation using the glucose pump test (GPT) in 25 patients (18 grafts, 7 fistulas) over three dialysis sessions.
  • Took nine Q measurements per patient (predialysis, hour 1, hour 3) within a 2-week period.

Related Experiment Videos

  • Calculated within-patient Q variation (short-term variation) and determined the influence of biological variation versus analytical error.

    • Main Results:

    • A deltaQ > 33% is significant at p < 0.05, while > 17% is significant at p < 0.20.
    • Biological variation significantly contributes to short-term Q variation, nearly matching it.
    • Analytical error has minimal impact on short-term Q variation.

    Conclusions:

    • Defined thresholds for significant deltaQ applicable to hemodialysis access surveillance for stenosis referral.
    • Threshold selection should balance avoiding thrombosis risk against minimizing unnecessary procedures.
    • Recommends a deltaQ threshold of > 33% when avoiding unnecessary procedures is prioritized.