Blood temperature monitoring-guided vascular access intervention improved dialysis adequacy

The aim of this study was to investigate whether blood temperature monitoring-guided vascular access intervention could improve dialysis adequacy.

We retrospectively evaluated all patients who received outpatient-based prevalent hemodialysis patients (n = 84) in our artificial kidney room between January 2019 and October 2019. Through blood temperature monitoring, access blood flow was calculated every month and Kt/V was calculated every 3 months. The reference point was set at the time of vascular intervention in the patients (n = 27) who underwent intervention or at the middle of the study period in patients (n = 57) who did not undergo intervention. The mean blood temperature monitoring-estimated access flow and Kt/V before and after the reference point were calculated and compared.

Among 84 patients, 30 (35.7%) showed access flow rates of <500 mL/min, calculated by blood temperature monitoring during the study period. Twenty-seven patients (32.1%) underwent vascular intervention, of whom 24 (28.6%) showed access flow rates of <500 mL/min, 2 (2.4%) showed weak bruit or thrill incapable of needling, and 1 (1.2%) presented acute occlusion. Six patients (7.1%) whose access flow rates were <500 mL/min refused to undergo intervention. All angiographies in the patients whose access flow rates were <500 mL/min who underwent intervention showed a significant stenosis. The mean change in blood temperature monitoring-estimated access flow and Kt/V before and after vascular intervention was 483.3 ± 490.6 and 0.19 ± 0.21, respectively, which showed significant differences (all p < 0.05). A weak positive correlation between the mean change in blood temperature monitoring-estimated access flow and Kt/V was shown in all study patients by Pearson's correlation analysis (r = 0.234, p = 0.033).

Access flow estimation by blood temperature monitoring might identify candidates who require vascular intervention. Blood temperature monitoring-guided vascular intervention significantly improved access flow and dialysis adequacy.