Dialysis Vascular Access

Introduction and Aims: On-line dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs. This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group. Methods: We studied 148 long-term hemodialysis patients with arteriovenous fistulas (historical control group, n = 74) for 2 years. During the study period, the indications for vascular treatments were the Kt reduction 20% with respect to baseline values or Qa less than 500 mL/min (or a decrease in flow > 20%). Differences between the Qa and Kt groups were tested using Student's T-Test or the Wilcoxon test, as appropriate. The 2 test was used to analyze the angioplasty and thrombosis rates compared with the historical control group. A P-value 0.05 was considered statistically significant. Results: During the study period, we detected 16 cases of significant vascular access dysfunction. The Kt value after vascular treatment was 71.1L (59L; P = 0.001) and BTM-Qa was 1218.6 mL/min (519.7 mL/min; P = 0.001). Compared with the control group, the thrombosis rate was 0.027 vs 0.148 episodes/patient-year (P = 0.009) and the total access-related cost was 22,293 vs 47,467 (P = 0.033). Conclusions: This study suggests that a combined monitoring program based on Kt and Qa-BTM represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments SP523