Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia.
Medical Faculty, University of Maribor, Maribor, Slovenia.
Blood Purif. 2022;51(1):15-22. doi: 10.1159/000514939. Epub 2021 Mar 30.
Monitoring of arteriovenous (AV) fistula to detect hemodynamically important stenosis is crucial for the prevention of AV fistula thrombosis. The aim of our study was to analyze the importance of dialysis dose (Kt/V) during online postdilution hemodiafiltration (HDF) for early detection of AV fistula stenosis.
Hemodialysis patients with AV fistula were included in this study. We compared a group of 44 patients who have undergone fistulography and subsequently percutaneous transluminal angioplasty (PTA) of significant AV fistula stenosis (active group) with a group of 44 age- and sex-matched patients without PTA (control group). Observational time in both groups was the same.
All patients had postdilution online HDF using a F5008 dialysis machine, which can measure online single-pool Kt/V. All data were analyzed during the performance of 2056 HDF procedures. In the active group, we found statistically significantly lower values of Kt/V, all 8 weeks before PTA. In the active group, there was a significant improvement in Kt/V in the first (p < 0.001) and second week (p = 0.049) after PTA. Three and 8 weeks after PTA, we did not find any statistically significant difference in Kt/V between both groups (p = 0.114; p = 0.058). Patients in the active group had statistically significantly lower substitution volumes and blood pump flow rates during HDF over the whole observation period before and after PTA. In contrast, there were no differences in venous pressure in the dialysis circuit between both groups throughout the observation period.
In hemodialysis patients with AV fistula, treated with online HDF, routine measurements of Kt/V during each HDF are a beneficial, quick, and straightforward method for early detection of hemodynamically significant AV fistula stenosis.
监测动静脉（AV）瘘以检测血流动力学重要狭窄对于预防 AV 瘘血栓形成至关重要。我们的研究目的是分析在线后稀释血液透析滤过（HDF）过程中透析剂量（Kt/V）对于早期检测 AV 瘘狭窄的重要性。
本研究纳入了 AV 瘘患者。我们比较了一组接受瘘造影检查并随后进行经皮腔内血管成形术（PTA）治疗明显 AV 瘘狭窄（活跃组）的 44 例患者和一组未进行 PTA 的年龄和性别匹配的 44 例患者（对照组）。两组的观察时间相同。
所有患者均使用 F5008 透析机能进行在线后稀释 HDF，该透析机能在线测量单池 Kt/V。所有数据均在 2056 次 HDF 过程中进行分析。在活跃组中，我们发现 PTA 前 8 周 Kt/V 值明显降低。在活跃组中，PTA 后第一周（p<0.001）和第二周（p=0.049）Kt/V 显著改善。在 PTA 后 3 周和 8 周，两组之间的 Kt/V 无统计学差异（p=0.114；p=0.058）。在 PTA 前后整个观察期间，活跃组患者的 HDF 中替代液体积和血液泵流量明显较低。相比之下，两组患者的透析回路静脉压在整个观察期间均无差异。
在接受在线 HDF 治疗的 AV 瘘血液透析患者中，常规测量每次 HDF 中的 Kt/V 是一种有益、快速且简单的方法，可早期检测血流动力学显著的 AV 瘘狭窄。
