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Nefrología (Madrid)

versión On-line ISSN 1989-2284versión impresa ISSN 0211-6995

Resumen

FONTSERE, Néstor et al. Practical utility of thermodilution versus doppler ultrasound to measure haemodialysis blood access flow. Nefrología (Madr.) [online]. 2013, vol.33, n.3, pp.325-332. ISSN 1989-2284.  http://dx.doi.org/10.3265/Nefrologia.pre2013.Jan.11748.

Introduction: The current clinical guidelines recommend indirect measurement of vascular access blood flow (Qa) as one of the most important components in vascular access maintenance programmes. The best-known methods are doppler ultrasound (DU) and saline dilution method. Objective: This study evaluates the efficiency of Qa measurement using the thermodilution method (TD) in comparison with DU. Material and Method: Cross-sectional study in 64 patients on haemodialysis (41 males); mean age: 59.9 years, with 54 AVFs and 10 PTFE. Qa reference values were obtained with DU in the brachial artery (AVFs) or at the zone of arterial puncture (PTFE). Bland-Altman and interclass correlation coefficients (ICC) were used to study accuracy. Results: Mean values obtained with DU-Qa were 1426 ± 753 mL/min for AVFs and 1186 ± 789mL/min for PTFE grafts. The mean Qa with TD was 1372 ± 770 for AVFs (bias: 54.6; ICC: 0.923) and 1176 ± 758 for PTFE (bias 10.2; ICC 0.992). In the 28 patients with radiocephalic side-to-end AVFs, the mean DU-Qa was 1232 ± 767mL/min. Qa values were measured in the radial artery: 942 (ICC 0.805); radial-ulnar artery: 1103 (ICC 0.973); cephalic vein: 788 (ICC 0.772), and with TD: 1026 (ICC 0.971). We detected 5 cases of significant stenosis. After endovascular treatment, mean Kt was 79 liters (61; P=.043) and mean TD-Qa was 895mL/min (663; P=.043). Conclusions: TD represents a good indirect method of Qa measurement. In patients with radiocephalic AVFs, Qa measurements in the radial and ulnar artery are more accurate. Therefore, in this situation the TD method obtained an excellent correlation with values taken from the brachial artery.

Palabras clave : Haemodialysis; Access blood flow (Qa); Doppler ultrasound; Thermodilution; Radiocephalic AVFs latero-terminal.

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