Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France.
Angiology Department, Arago Clinic, Paris, France.
Pediatr Nephrol. 2019 Nov;34(11):2381-2387. doi: 10.1007/s00467-019-04297-5. Epub 2019 Jul 19.
This study is aimed at comparing ultrasound dilution (UD) and thermodilution (TD) with color Doppler ultrasound (CDU) for arteriovenous fistula (AVF) assessment in children on hemodialysis (HD).
All patients were dialysed with the Fresenius 5008 HD machine. UD was performed using the Transonic device. The two methods were compared with CDU performed on a non-HD day. AVF flow rate was expressed as ml/min/1.73 m.
Sixteen measurements of AVF flow rate and recirculation with UD and TD were compared with CDU in 16 patients with a median weight of 39 kg. Both UD and TD overestimated AVF flow rate when compared with CDU (+437 (95% CI + 200, + 674) and + 476 (95% CI + 80, + 871) ml/min/1.73 m for UD and TD, respectively). CDU flow rate was significantly correlated to UD flow rate (r = 0.761, p < 0.001), but not to TD flow rate (r = 0.164, p = 0.120). Although recirculation in all AVF was estimated to be 0% and < 15% with UD and TD, respectively, 7 significant stenoses were diagnosed by CDU. AVF with stenosis had lower flow rates when measured by CDU, UD or TD, but only CDU measurements reached statistical significance (p = 0.008, p = 0.142 and p = 0.174, respectively).
UD and TD overestimate AVF flow rate when compared with CDU, which is the most reliable non-invasive method for screening vascular access for stenosis. UD seems more accurate than TD for AVF flow rate assessment. Recirculation via UD or TD should not be used for early screening of AVF stenosis in children on HD.
本研究旨在比较超声稀释（UD）和热稀释（TD）与彩色多普勒超声（CDU）在儿童血液透析（HD）患者动静脉瘘（AVF）评估中的应用。
所有患者均使用费森尤斯 5008 HD 机器进行透析。UD 使用 Transonic 设备进行。在非 HD 日，将这两种方法与 CDU 进行比较。AVF 流量表示为 ml/min/1.73 m。
在 16 名体重中位数为 39kg 的患者中，对 16 次 AVF 流量和再循环的 UD 和 TD 测量值与 CDU 进行了比较。与 CDU 相比，UD 和 TD 均高估了 AVF 流量（分别为+437（95%CI +200，+674）和+476（95%CI +80，+871）ml/min/1.73 m）。CDU 流量与 UD 流量显著相关（r=0.761，p<0.001），但与 TD 流量不相关（r=0.164，p=0.120）。尽管 UD 和 TD 分别估计所有 AVF 的再循环为 0%和 <15%，但 CDU 诊断出 7 个明显狭窄。狭窄的 AVF 的 CDU、UD 或 TD 测量的流量均较低，但只有 CDU 测量值具有统计学意义（p=0.008，p=0.142 和 p=0.174）。
与 CDU 相比，UD 和 TD 高估了 AVF 流量，而 CDU 是筛查血管狭窄最可靠的非侵入性方法。与 TD 相比，UD 似乎更准确地评估 AVF 流量。通过 UD 或 TD 的再循环不应用于儿童 HD 患者 AVF 狭窄的早期筛查。
