Flow Measurements Correlated With 4-Year Hemodialysis Survival Rates
From: “Access flow volume (Qa) and survival in a hemodialysis population: an analysis of 5208 Qa measurements over a 9-year period” by Reshabh Yadav, Michael W. M. Gerrickens, Sander M.J. van Kuijk, Roel H. D. Vaes, Maarten G. J. Snoeijs and Marc R. M. Scheltinga
Summary by Daniel Foster
In this cohort study, clinicians performed 5208 flow measurements on 165 patients (103 male, ages 58-82) at a single dialysis center over a 9-year period.
All patients had received a primary arteriovenous access (AVA) between 2010 and 2017, and baseline flow volume (Qa, in mL/min) was determined by two-needle dilution technique, only on well-functioning accesses, using a Transonic HD03 meter and Transonic’s Krivitsky Method dilution.
Optimal baseline Qa point was identified via Receiver Operated Characteristics curve, thereafter, population cross-section measurements were taken at 3-month intervals.
At follow-up, 36 months median from trial start, cardiovascular mortality (CVM) was 48% (79 individuals). Baseline Qa<900ml/min correlated with increased risk of CVM, and statistics were significant, with a hazard ratio greater than 4 at the 95% confidence interval.
At four-year End of Study cross-section, CVM was 34% lower in patients with Qa>900ml/min, with all null probabilities in the tenth’s digit or less. Interestingly, increasing Qa values throughout the study also showed statistical correlation to increased CVM.
This study unequivocally attests to the value of AVA flow measurement, and specifically Transonic’s HD03 and patented Krivitsky method, without which none of this groundbreaking data could have been obtained.
It is important to note that these understandings may be used to save future patients, and no comparable system for such determinations exists on the market. Transonic is a proud partner in this endeavor and congratulates the researchers on their results.
Reference: Nephrol Dial Transplant (2021) 1–7, doi: 10.1093/ndt/gfab242, Advance Access publication 12 August 2021