Association of access blood flow with patency loss of arteriovenous fistula in maintenance hemodialysis patients: ultrasound dilution versus color Doppler ultrasound
10.3760/cma.j.cn441217-20220830-00150
- VernacularTitle:超声稀释法及彩色多普勒超声监测的血液透析患者动静脉内瘘血流量与动静脉内瘘丧失功能的相关性
- Author:
Xizi ZHENG
1
;
Xiufang DUAN
;
Jinwei WANG
;
Yao LIU
;
Li MENG
;
Yanqi YIN
;
Qizhuang JIN
Author Information
1. 北京大学第一医院肾内科 北京大学肾脏疾病研究所 卫生部肾脏疾病重点实验室 慢性肾脏病防治教育部重点实验室（北京大学）中国医学科学院免疫介导肾病诊治创新单元，北京 100034
- Keywords:
Renal dialysis;
Arteriovenous fistula;
Ultrasonography;
Access flow
- From:
Chinese Journal of Nephrology
2022;38(12):1025-1031
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the association of access blood flow measured by ultrasound dilution and color Doppler ultrasound with patency loss of arteriovenous fistula (AVF).Methods:This was a bidirectional cohort study. The adult patients who underwent maintenance hemodialysis (MHD) with AVF in Peking University First Hospital from January 1, 2018 to July 31, 2020 were enrolled. AVF blood flow was measured by ultrasonic dilution method (Qa), and color Doppler ultrasound in cephalic vein and brachial artery. Patients were divided into low Qa (<500 ml/min), normal Qa (500-1 500 ml/min) and high Qa (>1 500 ml/min) groups according to baseline AVF blood flow measured by ultrasonic dilution method. Qa was monitored every 3 months within the first year. The endpoint events of follow-up were defined as AVF patency loss or death. The deadline of the follow-up was July 31, 2022. Linear regression analysis was used to assess the change trend of Qa. Fine and Gray competitive risk model was used to evaluate the cumulative incidence of AVF patency loss. The Cox proportional hazards regression model was used to evaluate the association between access AVF blood flow and patency loss.Results:A total of 163 patients were enrolled, with age of (57.0±13.7) years old and 110 males (67.5%). The median follow-up time was 45(22, 53) months. Forty-four patients (27.0%) had AVF failure, and 29 patients (17.8%) died. The cumulative incidence rates of AVF patency loss in patients with low Qa, low blood flow of brachial artery and cephalic vein (<500 ml/min), and in those with a downward trend of Qa were higher than those in patients with normal or high blood flow, and in those with a upward trend of Qa (Gray′s test, all P<0.05). After adjusted for age, sex, age of fistula, diabetes and vascular stenosis, multivariable Cox regression analysis results showed that baseline Qa<500 ml/min ( HR=3.508, 95% CI 1.382-8.905, P=0.008), baseline brachial artery flow<500 ml/min ( HR=2.413, 95% CI 1.058-5.503, P=0.036) and a downward trend of Qa ( HR=2.498, 95% CI 1.241-5.027, P=0.010) were independently associated with AVF patency loss. Conclusions:Patients with low baseline value or downward trend of AVF blood flow are at significantly higher risk of patency loss. The brachial artery measurement of AVF blood flow is the preference location for color Doppler ultrasonic.
