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Comparison of clinical assessment with ultrasound flow for hemodialysis access surveillance.

Schuman E, Ronfeld A, Barclay C, Heinl P

Oregon Surgical Consultants, 1130 NW 22nd St, Ste 300, Portland, OR 97210, USA. schumane@earthlink.net

HYPOTHESIS: Organized clinical assessment of hemodialysis access is as useful a surveillance tool as ultrasound flow measurements in preventing access thrombosis. DESIGN: Cohort analysis comparing a dialysis unit evaluated using ultrasound flow measurements with another unit evaluated clinically. SETTING: University-affiliated community program with private and health maintenance organization dialysis units. PATIENTS: One hundred patients in each unit were enrolled. Patients who were unavailable for follow-up or died within the first 30 days of enrollment were excluded from further analysis. INTERVENTION: Angiograms were obtained in the Transonics Doppler ultrasound system (Transonics Systems Inc, Ithaca, New York) cohort if graft flow was less than 600 mL/min, fistula flow was less than 450 mL/min, or flow decreased more than 25%, and in the clinical cohort if there was a change in the access appearance, change in the bruit, or a sharp increase in venous resistance. MAIN OUTCOME MEASURES: Primary and secondary patencies of the hemodialysis access were analyzed for each cohort. Subset analysis was obtained for synthetic grafts and native fistulas. Procedures were assessed for each cohort. RESULTS: The patients in the clinical cohort had similar primary patency (1199 days) as in the Transonics cohort (1162 days) (P = .92). Angiographic procedures were also similar, with 56% of all patients having none. The mean number of procedures was 0.56 per patient in the Transonics cohort and 0.48 in the clinical group (P = .48). CONCLUSION: An organized clinical assessment, using a formal tracking tool, is equal to ultrasound flow measurements as a surveillance method to prevent hemodialysis access thrombosis.

Published 18 December 2007 in Arch Surg, 142(12): 1129-33.
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