Department of Medicine, Division of Nephrology, Harlem Hospital, Columbia University Medical Center, New York, NY, USA.
ASAIO J. 2012 Sep-Oct;58(5):522-5. doi: 10.1097/MAT.0b013e318263210b.
Vascular catheter use for dialysis remains highly prevalent, however, it is frequently adversely affected by access recirculation (AR). We previously reported the utility of effective ionic dialysance (EID)/blood flow rate (Qb) ratio in identifying significant (>5%) AR in arteriovenous (AV) fistulas (Mohan et al ASAIO J 56:427-433, 2010). We present data from 58 patients, receiving hemodialysis via venous catheters (85% tunneled cuffed catheters) who underwent intermittent monitoring for AR with the saline dilution technique (Transonic HD02 monitor) and had EID and Qb measurements from Diascan biosensor in the Gambro Phoenix dialysis machine available. Among the 193 hemodialysis sessions studied, 74 instances of significant access recirculation (sAR) were identified. A higher incidence of sAR occurred with temporary catheters and catheters in the femoral vein. We report a significant correlation between the EID/Qb ratio and AR in addition to demonstrating the predictive utility of the ratio for identifying dysfunction catheters with sAR (area under the receiver operator characteristic curve of 0.86 with a sensitivity of 79% and a specificity of 76% at an EID/Qb ratio of ≤ 0.60). Our data demonstrate the utility of the EID/Qb ratio as an indicator of sAR in dialysis catheters albeit at a different threshold than that seen with AV fistulae.
血管内导管用于透析仍然非常普遍，然而，它经常受到通路再循环（AR）的不利影响。我们之前报道了有效离子透析率（EID）/血流率（Qb）比值在识别动静脉（AV）瘘管中（Mohan 等人 ASAIO J 56:427-433, 2010）显著（>5%）AR 的效用。我们展示了 58 名接受静脉导管血液透析（85%带隧道的带套囊导管）患者的数据，这些患者通过盐水稀释技术（Transonic HD02 监测仪）间歇性监测 AR，并在 Gambro Phoenix 透析机上的 Diascan 生物传感器测量 EID 和 Qb。在研究的 193 次血液透析中，发现了 74 例明显的通路再循环（sAR）。临时导管和股静脉导管的 sAR 发生率更高。我们报告了 EID/Qb 比值与 AR 之间的显著相关性，并证明了该比值对识别具有 sAR 的功能障碍导管的预测效用（EID/Qb 比值≤0.60 时，接收者操作特征曲线下面积为 0.86，灵敏度为 79%，特异性为 76%）。我们的数据表明，EID/Qb 比值可作为透析导管中 sAR 的指标，尽管其阈值与 AV 瘘管不同。
