Sensing Savvy

When an access suddenly clots or thromboses, all stakeholders are confronted with a crisis that must be immediately resolved.

Needless to say, the end-stage renal disease (ESRD) patient has the most at stake and can suffer the most. He or she must cope with:

When one sets the pump on a hemodialysis machine, one naturally assumes that the pump will deliver what it is set at. However, myriad factors can alter the pump flow so the flow being actually delivered to the patient is not the flow the pump is set at. These factors include the following:

“A hemodynamically significant stenosis is the substrate for thrombosis by reducing flow, increasing turbulence, and increasing platelet activation and residence time against the vessel wall.” KDOQI Guidelines 2006³ 

End-stage-renal-disease (ESRD) is devastating. In 2014, 118,000 people in the United States started treatment for ESRD, and 662,000 were living on chronic dialysis or with a kidney transplant.

“A hemodynamically significant stenosis is the substrate for thrombosis by reducing flow, increasing turbulence, and increasing platelet activation and residence time against the vessel wall.”

KDOQI Guidelines 2006¹

Congestive heart failure (CHF) and pulmonary hypertension are well-known complications of high-flow hemodialysis access. Although ‘high flow’ is subjective, since every patient has a threshold of access flow that will induce such failure (as well as distal extremity ischemia), Fistula First uses a minimal threshold of 2 L/min flow to refer the patient for cardiac evaluation.

“The ability to monitor cardiac output is one of the important cornerstones of hemodynamic assessment ...in particular in patients with pre-existing cardiovascular comorbidities.”¹

Mortality rates of cardiovascular disease patients on hemodialysis are approximately 30 times that of the general population. Cardiovascular disease (CVD) accounts for half of the deaths and one-third of hospitalizations of these dialysis patients. Their congestive heart failure results from cardiac overload, anemia, severe hypertension and cardiac dysfunction due to the rapid removal of large volumes of fluid during hemodialysis that severely tests the limits of a patient’s cardiac function, which can change dramatically during a hemodialysis treatment.^2-5

Access excellence is the mission of the Vascular Access Society of the Americas (VASA). Founded in 2005, VASA is devoted to the advancement of the field of dialysis access through multi-disciplinary collaboration, research, education and advocacy for patients with end stage kidney disease.

A 75-year-old female patient with a central venous catheter underwent a Flow-QC test with a Transonic Hemodialysis Monitor. Her blood lines were in a normal line position. The pump setting on the hemodialysis machine was 290 mL/min. The Flow-QC test measured Delivered Blood Flow at 190 mL/min along with no recirculation.

“Very high reproducibility and negligible impact of flow (Qb) on vascular access flow (QVA) determination justifies the current ultrasound dilution status as a reference method in QVA evaluation.” Lopot et al¹