Static pressures, intra-access blood flow and dynamic Kt/V profiles in the prediction of dialysis access function

• 作者: Abhilash Koratala Abutaleb A Ejaz Bhagwan Dass Girish Singhania Kawther F Alquadan Simrun Sharma
• 来源期刊: 世界肾病学杂志:英文版
• 学科: 医学
• 关键词: STATIC Intra-access Pressures HEMODIALYSIS KT/V
• 年，卷（期）: 2019,（3）
• 页码范围: 59-66
• 页数: 8页
• 分类号: R

摘要

BACKGROUND Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were associated with abnormal Kt/V values, high access recirculation and deviation of the Kt/V profile (Abnormal Kt/V profile) from normally expected values (Normal Kt/V profile). AIM To hypothesize that static or derived access pressures would correlate with direct intra-access blood flow rates and that clearance (Kt/V) profiles would correlate with measured Kt/V values. METHODS Static access pressures, real-time adequacy of dialysis and intra-access blood flow were investigated in end stage renal disease patients undergoing hemodialysis. Wilcoxon-Mann-Whitney test, chi-square test or Fisher’s exact test was used to investigate differences between the groups;Spearman’s rank correlation test to investigate relationships between static pressures, direct intra-access pressures and Kt/V profiles;and multinomial logistic regression models to identify the independent effect of selected variables on Kt/V profiles. Odds ratio were calculated to measure the association between the variables and Kt/V profiles. RESULTS One hundred and seven patients were included for analysis. There were no significant differences between genders, and types of vascular access between the normal vs. abnormal clearance (Kt/V) profile groups. No significant correlation could be demonstrated between static access pressures and Kt/V profiles, static access pressures and intra-access blood flow, intra-access blood flow and Kt/V profiles, measured Kt/V and Kt/V profiles or recirculation and Kt/V profiles. CONCLUSION In this study utilizing measured versus estimated data, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. These parameters, though useful estimates, cannot be accept