静态内瘘压力比值与内瘘血流量不相关。

Static intra-access pressure ratio does not correlate with access blood flow.

作者信息

Spergel Lawrence M, Holland Janet E, Fadem Stephen Z, McAllister Charles J, Peacock Eileen J

机构信息

Dialysis Management Medical Group, San Francisco, California 94109, USA.

出版信息

Kidney Int. 2004 Oct;66(4):1512-6. doi: 10.1111/j.1523-1755.2004.00946.x.

DOI:10.1111/j.1523-1755.2004.00946.x

PMID:15458445

Abstract

BACKGROUND

Access flow (Qa) measurement is recommended by Kidney Disease Outcomes Quality Initiative (K/DOQI) as the preferred method for access surveillance. Static intra-access pressure ratio (SIAPR) measurement is the second surveillance method of choice. The purpose of this prospective multicenter study was to investigate the relationship between SIAPR and Qa and to examine the premise upon which SIAPR surveillance is based-namely, that high SIAPR is a surrogate for low Qa associated with hemodynamically significant stenosis.

METHODS

SIAPR and Qa (HD01; Transonic Systems, Inc., Ithaca, NY, USA) were simultaneously measured monthly in 242 patients [146 prosthetic arteriovenous bridge grafts (AVG), 96 autogenous arteriovenous fistulas (AVF)] from three centers. SIAPR was measured according to the K/DOQI protocol.

RESULTS

There was no correlation between Qa and venous or arterial SIAPR in AVGs (R(2)= 0.0037 and R(2)= 0.006, respectively, N= 730), or in AVFs (R(2)= 0.0247 and R(2)= 0.0329, respectively, N= 431). Of the high SIAPR measurements in AVGs, 81% and 50% were associated with Qa > or =600 and Qa > or =1000 mL/min, respectively. Of the AVGs studied, 41% (60/146) had consistently high Qa > or =1000 mL/min. Seventy percent (42/60) of these high-Qa AVGs had at least two consecutive sessions with high SIAPR measurements, thereby meeting the K/DOQI SIAPR criteria for referral. In addition, 78% (14/18) of new AVGs with Qa > or =1000 mL/min, and 86% (6/7) of AVGs with the highest Qa (> or =2000 mL/min), had high SIAPR. As a result, these high-Qa AVGs, which represented the best functioning AVGs by K/DOQI Qa standards, were erroneously targeted for referral based on SIAPR measurements.

CONCLUSION

SIAPR does not correlate with Qa or discriminate between high and low Qa. Therefore, because the utility of SIAPR surveillance for detection of clinically significant stenosis depends on a correlation with Qa, the current use of absolute K/DOQI SIAPR thresholds for intervention based on the presumption that such thresholds are indicative of low Qa is not justified, and should be discontinued. Studies need to be done to examine the utility of SIAPR for trend analysis.

摘要

背景

美国肾脏病预后质量倡议组织（K/DOQI）推荐血流量（Qa）测量作为血管通路监测的首选方法。静态血管内压力比值（SIAPR）测量是第二种可供选择的监测方法。这项前瞻性多中心研究的目的是探讨SIAPR与Qa之间的关系，并检验SIAPR监测所依据的前提，即高SIAPR是与血流动力学显著狭窄相关的低Qa的替代指标。

方法

来自三个中心的242例患者[146例人工动静脉移植血管（AVG），96例自体动静脉内瘘（AVF）]每月同时测量SIAPR和Qa（HD01；美国纽约伊萨卡的Transonic Systems公司）。根据K/DOQI方案测量SIAPR。

结果

在AVG中（分别为R² = 0.0037和R² = 0.006，N = 730），以及在AVF中（分别为R² = 0.0247和R² = 0.0329，N = 431），Qa与静脉或动脉SIAPR之间均无相关性。在AVG中，SIAPR测量值较高的情况里，分别有81%和50%与Qa≥600和Qa≥1000 mL/min相关。在所研究的AVG中，41%（60/146）的Qa始终≥1000 mL/min。这些高Qa的AVG中有70%（42/60）至少有两个连续测量期的SIAPR测量值较高，从而符合K/DOQI的SIAPR转诊标准。此外，Qa≥1000 mL/min的新建AVG中有78%（14/18），以及Qa最高（≥2000 mL/min）的AVG中有86%（6/7）的SIAPR较高。因此，这些根据K/DOQI的Qa标准属于功能最佳的AVG，却因SIAPR测量值而被错误地列为转诊对象。