Goldstein S L, Allsteadt A
Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA.
Kidney Int. 2001 Jun;59(6):2357-60. doi: 10.1046/j.1523-1755.2001.00753.x.
Hemodialysis access thrombosis is a significant cause of morbidity for hemodialysis patients and results from decreased access flow caused by venous outflow tract stenosis. Ultrasound dilution (UD) is a practical, noninvasive, and reliable indicator of access flow and is effective in predicting venous stenosis in adult patients receiving hemodialysis.
The current study is the first to our knowledge to evaluate the accuracy of UD in predicting hemodialysis access stenosis in a pediatric hemodialysis population. Thirteen pediatric patients receiving hemodialysis via permanent access (4 AVF and 9 AVG) received 73 UD measurements over three months.
Mean raw access flow (QA) was 720 +/- 428 mL/min, and mean corrected access flow (QAcorr) was 886 +/- 537 mL/min/1.73 m(2). QAcorr was significantly lower in accesses with stenosis (401 +/- 176 mL/min/1.73 m(2)) versus accesses without stenosis (1158 +/- 330 mL/min/1.73 m(2), P < 0.0001). Unlike flow values reported by raw QA, there was no overlap in flow values reported by QAcorr in accesses with stenosis (174 to 579 mL/min/1.73 m(2)) versus accesses without stenosis (709 to 1711 mL/min/1.73 m(2)). Two patients with an AVG who had QAcorr less than 600 mL/min/1.73 m(2) developed an access thrombosis within one week after UD measurement. No patients with QAcorr greater than 700 mL/min/1.73 m(2) developed access thrombosis in the 30 days following UD measurement.
: The current study supports the use of monthly UD measurement to prevent access thrombosis in children receiving hemodialysis.
血液透析通路血栓形成是血液透析患者发病的重要原因，其由静脉流出道狭窄导致的通路血流量减少引起。超声稀释法（UD）是一种实用、无创且可靠的通路血流量指标，在预测接受血液透析的成年患者静脉狭窄方面有效。
据我们所知，本研究是首次评估UD在预测儿科血液透析人群血液透析通路狭窄准确性的研究。13例通过永久性通路接受血液透析的儿科患者（4例自体动静脉内瘘和9例人工血管动静脉内瘘）在三个月内接受了73次UD测量。
平均原始通路血流量（QA）为720±428 mL/分钟，平均校正通路血流量（QAcorr）为886±537 mL/分钟/1.73 m²。狭窄通路的QAcorr（401±176 mL/分钟/1.73 m²）显著低于无狭窄通路（1158±330 mL/分钟/1.73 m²，P<0.0001）。与原始QA报告的流量值不同，狭窄通路（174至579 mL/分钟/1.73 m²）与无狭窄通路（709至1711 mL/分钟/1.73 m²）的QAcorr报告的流量值没有重叠。两名人工血管动静脉内瘘患者的QAcorr低于600 mL/分钟/1.73 m²，在UD测量后一周内发生了通路血栓形成。在UD测量后的30天内，没有QAcorr大于700 mL/分钟/1.73 m²的患者发生通路血栓形成。
本研究支持每月进行UD测量以预防接受血液透析儿童的通路血栓形成。
