Venous Pressure Monitoring As a Predictor Of High-Flow Access In Prevalent Hemodialysis Patients

Ain Shams University59 enrolled

Overview

This study aimed to detect the possibility of using venous pressure as a predictor for high flow access as a simple, non-invasive screening technique in hemodialysis patients.

The patient's vascular access is often referred to as their "lifeline," and without it, the life-sustaining treatment of hemodialysis would not be possible. To maintain access, patency depends on accurate diagnosis and timely, active interventions. The Kidney Disease Outcomes Quality Initiative (K/DOQI) recommends native arteriovenous fistula (AVF) as the vascular access of choice for hemodialysis due to its longevity, lower complications, and lower mortality rate compared to catheters. Currently, K/DOQI guidelines suggest that high intra-access pressure may be regarded as a surrogate for arteriovenous fistula (AVF) outflow stenosis. It can be measured using static venous pressure (sVP) or standardized dynamic venous pressure (dVP).

Study Type

OBSERVATIONAL

Enrollment

Conditions

Venous Pressure Predictor High Flow Access Hemodialysis

Interventions

Venous Pressure MonitoringOTHER

Measurement of venous pressure will be taken at dialysis machine pump speed set at 200ml/min, fistula needle gauge 16.

Color Doppler UltrasoundOTHER

Arteriovenous fistula (AVF) Access flow (QA) will be obtained using color Doppler ultrasound using the Mindray-M5 ultrasound system. AVF feeding arterial flow will be measured immediately proximal to the fistula. The QA volume will be obtained using the algorithm available on the system, which is based on the mean flow of two measurements.

Eligibility

Sex: ALLMin age: 28 YearsMax age: 81 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age from 28 to 81. * Both sexes. * Patients with the presence of an autogenous arteriovenous fistula (AVF) and a minimum hemodialysis treatment duration of six months. Exclusion Criteria: * Physical examination revealed signs of AVF outflow stenosis, including localized edema, collateral circulation, hyperpulsatile fistula characteristics, or a positive hand elevation test. * If ultrasound confirmed AVF stenosis or thrombosis, or angiography identified central venous stenosis or thrombosis in clinically suspected cases.

Locations (1)

Ain Shams University

Cairo, Egypt

Outcomes

Primary Outcomes

Static venous pressure

Static venous pressure (SVP) were measured with the blood pump deactivated through direct intra-access measurement via the venous outflow cannulation needle. Blood pressure (BP)-adjusted values were calculated using the patient's mean arterial blood pressure (MAP) recorded contemporaneously with venous pressure measurements.

Time frame: 6 months post-procedure

Secondary Outcomes

Standardized dynamic venous pressure

Standardized dynamic venous pressure (sDVP) measurements were performed with the hemodialysis machine blood pump calibrated to deliver 200 ml/min within five minutes of treatment initiation, utilizing a standardized 16-gauge venous outflow cannulation needle for measurement consistency.

Time frame: 6 months post-procedure

Arteriovenous fistula flow

Arteriovenous fistula flow (Qa) was quantified using a Mindray-M5 US system with integrated flow calculation algorithms. Feeding arterial blood velocity and vessel diameter measurements were obtained approximately 2 cm proximal to the fistula anastomosis. Flow calculations were based on the mean of two independent measurements, and patients demonstrating US evidence of stenosis or thrombosis were excluded from further analysis.

Time frame: 6 months post-procedure

Urea reduction ratio

Urea reduction ratio (URR) was subsequently calculated as an indicator of hemodialysis treatment adequacy.

Time frame: 30 minutes following treatment completion

Data from ClinicalTrials.gov

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