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Titolo Thermodilution versus saline dilution method for vascular access blood flow measurement in high-flux and on-line hemodiafiltration
Autore Néstor Fontseré1, Francisco Maduell1, Miquel Blasco1, Manel Vera1, Marta Arias1, Gaspar Mestres2, Patricia Bermudez3, Josep M. Campistol1 - 1Department of Nephrology, Vascular Access Unit, Hospital Clinic, University of Barcelona – Spain / 2Department of Vascular Surgery, Vascular Access Unit, Hospital Clinic, University of Barcelona – Spain / 3Department of Interventional Vascular Radiology, Vascular Access Unit, Hospital Clinic, University of Barcelona - Spain
Referenza J Vasc Access 2012; DOI: 10.5301/jva.5000091

Purpose: Access blood flow (Qa) measurements are one of the most important components in vascular access monitoring programs, even though these indirect methods have only been validated with high-flux hemodialysis (HF; pump flow [Qb] 300 mL/min). This study was to assess the utility from thermodilution (BTM) with respect to the saline dilution method (SDM) in HF and on-line hemodiafiltration (OL-HDF) with routinely prescribed parameters in comparison with validation conditions.

Methods: Three consecutive sessions were assessed in 31 hemodialysis patients (27AVF). The Bland-Altman method and Lin’s concordance coefficient (ρc) were used to study accuracy and precision. We used the student t test for the analysis of Qavalue in the different subgroups.

Results: In HF-hemodialysis 1 (Qb 300 mL/min), Qa was 1109 ± 541 mL/min SDMa and 1213 ± 639 mL/min BTM (P=.993a; bias 103.7 mL/min and ρc 0.78). In HF-hemodialysis 2 (Qb 420 mL/min) Qa 1071 ± 578 mL/min SDM (P=1.0a; -38.2 mL/min and 0.96) and 1216 ± 667 mL/min BTM (P=.992a; 127.3 mL/min and 0.70). In OL-HDF hemodialysis 3 (Qb 420 mL/min) Qa 1071 ± 510 mL/min SDM (P=1.0a; -48.4 mL/min and 0.96) and 1219 ± 580 mL/min BTM (P=.977a; 99.2 mL/min and 0.75). Statistically significant differences were only obtained in patients aged ≥ 65 years old (P=.016) and peripheral vascular disease (P=.007).

Conclusions: Our results demonstrate how the saline dilution method was more accurate than thermodilution in the HF and OL-HDF modalities with routinely prescribed parameters. Finally, in this study, advanced age (>65 years old) and peripheral vascular disease were associated with a significantly lower Qa-value.

Data 11.03.2013
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