BACKGROUND AND OBJECTIVES: Guidelines recommend systematically screening for stenosis using various methods, but no studies so far have compared all of the options. A prospective blinded study was performed to compare the performance of several bedside tests performed during dialysis in diagnosing angiographically proven >50% fistula stenosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In an unselected population of 119 hemodialysis patients with mature fistulas, physical examination (PE) was conducted; dynamic and derived static venous pressure (VAPR), blood pump flow/arterial pressure (Qb/AP) ratio, recirculation (R), and access blood flow (Qa) were measured; and angiography was performed. RESULTS: Angiography identified 59 stenotic fistulas: 43 stenoses were located upstream from the venous needle (inflow stenosis), 12 were located downstream (outflow stenosis), and 4 were located at both sites. The optimal tests for identifying an inflow stenosis were Qa < 650 ml/min and the combination of a positive PE "or" Qa < 650 ml/min (accuracy 80% and 81%, respectively), the latter being preferable because it was more sensitive (85% versus 65%, respectively) for a comparable specificity (79% versus 89%, respectively). The best tests for identifying outflow stenosis were PE and VAPR, with no difference between the two (accuracy 91% and 85%, sensitivity 75% and 81%, specificity 93% and 86%, respectively), the former being preferable because it was more reproducible, easier to perform, and applicable to all fistulas. CONCLUSIONS: This study showed that fistula stenosis can be detected and located during dialysis with a moderate-to-excellent accuracy using PE and Qa measurement as screening procedures.
BACKGROUND AND OBJECTIVES: Guidelines recommend systematically screening for stenosis using various methods, but no studies so far have compared all of the options. A prospective blinded study was performed to compare the performance of several bedside tests performed during dialysis in diagnosing angiographically proven >50% fistula stenosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In an unselected population of 119 hemodialysis patients with mature fistulas, physical examination (PE) was conducted; dynamic and derived static venous pressure (VAPR), blood pump flow/arterial pressure (Qb/AP) ratio, recirculation (R), and access blood flow (Qa) were measured; and angiography was performed. RESULTS: Angiography identified 59 stenotic fistulas: 43 stenoses were located upstream from the venous needle (inflow stenosis), 12 were located downstream (outflow stenosis), and 4 were located at both sites. The optimal tests for identifying an inflow stenosis were Qa < 650 ml/min and the combination of a positive PE "or" Qa < 650 ml/min (accuracy 80% and 81%, respectively), the latter being preferable because it was more sensitive (85% versus 65%, respectively) for a comparable specificity (79% versus 89%, respectively). The best tests for identifying outflow stenosis were PE and VAPR, with no difference between the two (accuracy 91% and 85%, sensitivity 75% and 81%, specificity 93% and 86%, respectively), the former being preferable because it was more reproducible, easier to perform, and applicable to all fistulas. CONCLUSIONS: This study showed that fistula stenosis can be detected and located during dialysis with a moderate-to-excellent accuracy using PE and Qa measurement as screening procedures.
Authors: Thomas McGinn; Peter C Wyer; Thomas B Newman; Sheri Keitz; Rosanne Leipzig; Gordon Guyatt For Journal: CMAJ Date: 2004-11-23 Impact factor: 8.262
Authors: Christoph Schwarz; Christa Mitterbauer; Maryla Boczula; Thomas Maca; Martin Funovics; Georg Heinze; Matthias Lorenz; Josef Kovarik; Rainer Oberbauer Journal: Am J Kidney Dis Date: 2003-09 Impact factor: 8.860
Authors: Jennifer M MacRae; Christine Dipchand; Matthew Oliver; Louise Moist; Charmaine Lok; Edward Clark; Swapnil Hiremath; Joanne Kappel; Mercedeh Kiaii; Rick Luscombe; Lisa M Miller Journal: Can J Kidney Health Dis Date: 2016-09-27