SP596EARLY DETECTION OF THE STENOSIS IN THE HEMODIALYSIS ARTERIOVENOUS FISTULA USING ROUTINELY MEASUREMENT OF THE DIALYSIS DOSE KT/V

Abstract

INTRODUCTION: Monitoring of a functional native arteriovenous fistula (AVF) to detect a hemodynamically important stenosis is crucial for the prevention of AVF thrombosis. The aim of our study was to analyse the importance of dialysis dose Kt/V during each online post-dilution hemodiafiltration (HDF). METHODS: End-stage renal disease (ESRD) patients with AVF were included in this analysis. In our dialysis centre we routinely measure Kt/V during every online HDF procedure. If the patient had diminishing of Kt/V we performed the Doppler ultrasound of AVF. We retrospectively compared a group of 23 patients who had Doppler ultrasound, fistulography and subsequently percutaneous transluminal angioplasty (PTA) of significant AVF stenosis with a group of 23 age- and sex-matched randomly selected patients without PTA. Observational time of the group without PTA was the same as the observation time of the group with PTA. RESULTS: All patients (28 men; mean age 64±15years, mean dialysis vintage 61months; 21(46%) diabetics) had post-dilution online HDF using F5008 dialysis machine, which can measure online single pool Kt/V. We found statistical significant difference between both groups in the presence of the diabetes (p=0.038), Kt/V values in the timeframe from 3 weeks before and 3 weeks after PTA (Table 1), blood pump flow rate and substitution volume one week before and one week after PTA (p<0.002). Using paired samples t-test we found statistical significant differences only in a group of patients with PTA: decrease of Kt/V one week before PTA (p=0.001) and increase of Kt/V one week after PTA (p=0.006), increase of the substitution volume one week after PTA (p=0.022), decrease of the blood pump flow rate one week before PTA (p=0.048) and increase of the blood pump flow rate one week after PTA (p=0.016). CONCLUSIONS: In ESRD patients with native AVF treated with online HDF routinely measurements of Kt/V during each HDF is very useful, simple and quick method for early detection of the hemodynamically significant stenosis of AVF. (Table Presented).