Chávez-Guzmán L, Zárraga-Rodríguez JL, Serrano-Lozano JA, Bravo-Arriola E

Language: Spanish
References: 18
Page: 62-68
PDF size: 173.96 Kb.

ABSTRACT

Introduction: Vascular access remains a major cause of hospitalization and morbidity in patients with chronic kidney disease (CKD) stage 5. The proper care of HD patients with CKD stage 5 requires constant attention to the maintenance of vascular access patency and function. Of hits available, surgically created fistula is closer to meeting these criteria. As important as the precision of the method, the objective of any method of monitoring is to detect stenosis timely access to the appropriate correction can be performed before thrombosis.
Material and methods: A clinical study with retrospective nonrandomized. We included patients from Hospital Regional Lic. Adolfo López Mateos who met inclusion criteria currently diagnosed with CKD in renal function replacement with hemodialysis via arteriovenous fistula of native vessels. Patients underwent duplex Doppler ultrasound studies in which measurements were made.
Results: 18 (51.4%) had stenosis and 17 ultrasonography showed no signs consistent (48.6%). Of the 27 patients with no evidence of physical examination abnormalities, about half (12 or 44%) presented stenosis itself. However, the confidence interval includes 95% (0.638-22.042) is not statistically significant. Further studies are needed to confirm this risk.
Conclusion: The duplex Doppler ultrasound is a useful method for the detection of patients at high risk of fistula loss since it is non-invasive, accessible and can be used at any time of the ripening thereof, and should be part of the routine evaluation of patients during the useful life of the fistula.

REFERENCES

1. KDOQI HD Adequacy guidelines for 2006 (National Kidney Foundation). KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 2006; 48(Suppl. 1): S1-S322.

2. Mayers JD, Markell MS, Cohen LS, Hong J, Lundin P, Friedman EA. Vascular access surgery for maintenance hemodialysis. Variables in hospital stay. ASAIO J 1992; 38: 113-5.

3. The Cost Effectiveness of Alternative Types of Vascular access and the Economic Cost of ESRD. Bethesda MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995, p. 139-57.

4. Planken RN, Tordoir JH, Dammers R, et al. Stenosis detection in forearm hemodialysis arteriovenous fistulae by multiphase contrast-enhanced magnetic resonance angiography: Preliminary experience. J Magn Reson Imaging 2003; 17: 54-64.

5. Robbin ML, Oser RF, Allon M, et al. Hemodialysis access graft stenosis: US detection. Radiology 1998; 208: 655-61.

6. Bosman PJ, Boereboom FT, Smits HF, Eikelboom BC, Koomans HA, Blankestijn PJ. Pressure or flow recordings for the surveillance of hemodialysis grafts. Kidney Int 1997; 52: 1084-8.

7. Gadallah MF, Paulson WD, Vickers B, Work J. Accuracy of Doppler ultrasound in diagnosing anatomic stenosis of hemodialysis arteriovenous access as compared with fistulography. Am J Kidney Dis 1998; 32: 273-7.

8. Schwarz C, Mitterbauer C, Boczula M, et al. Flow monitoring: Performance characteristics of ultrasound dilution versus color Doppler ultrasound compared with fistulography. Am J Kidney Dis 2003; 42: 539-45.

9. Asif A, Gadalean FN, Merrill D, et al. Inflow stenosis in arteriovenous fistulas and grafts: A multimulticenter, prospective study. Kidney Int 2005; 67: 1986-92.

10. Beathard GA. Physical examination of AV grafts. Semin Dial 1996; 5: 74-6.

11. Beathard GA. Physical examination: The forgotten tool. In: Gray RJ, Sands JJ (eds.). Dialysis Access: A Multidisciplinary Approach. Philadelphia, P.A.: Lippincott Williams & Wilkins; 2002, p. 111-8.

12. Trerotola SO, Scheel PJ Jr., Powe NR, et al. Screening for dialysis access graft malfunction: Comparison of physical examination with US. J Vasc Interv Radiol 1996; 7: 15-20.

13. Asif A, León C, Orozco-Vargas LC, Krishnamurthy G, Choi KL, Mercado C, et al. Accuracy of physical examination in the detection of arteriovenous fistula stenosis. Clin J Am Soc Nephrol 2007; 2(6): 1191-4.

14. Campos RP, Chula DC, Perreto S, Riella MC, Do Nascimento MM. Accuracy of physical examination and intra-access pressure in the detection of stenosis in hemodialysis arteriovenous fistula. Semin Dial 2008; 21(3): 269-73.

15. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial 2005; 18(4): 331-5.

16. Trerotola SO, Scheel PJ Jr., Powe NR, Prescott C, Feeley N, He J, et al. Screening for dialysis access graft malfunction: comparison of physical examination with US. J Vasc Interv Radiol 1996; 7(1): 15-20.

17. Schwarz C, Mitterbauer C, Boczula M, Maca T, Funovics M, Heinze G, et al. Flow monitoring: performance characteristics of ultrasound dilution versus color Doppler ultrasound compared with fistulography. Am J Kidney Dis 2003; 42(3): 539-45.

18. Salman L, Ladino M, Alex M, Dhamija R, Merrill D, Lenz O, et al. Accuracy of ultrasound in the detection of inflow stenosis of arteriovenous fistulae: results of a prospective study. Semin Dial 2010; 23(1): 117-21.