“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

A hemodialysis patient’s vascular access is his or her lifeline. If it fails, underdialysis can occur that can lead to costly hospitalizations.¹ The National Kidney Foundation’s Kidney Disease Outcome Quality Initiative (KDOQI) Guidelines, the European Renal Association-European Dialysis and Transplant Association’s (ERA-EDTA) European Best Practice Guidelines on Haemodialysis, the Australian CARI and Canadian Guidelines all advise proactive vascular access management.^1-4

KDOQI Guidelines recommend surveillance at least once a month to diagnose asymptomatic, but hemodynamically significant stenosis to prevent progression to a functionally significant stenosis, the substrate for thrombosis. According to KDOQI Guidelines, these monthly measurements should be, “tabulated and tracked within each dialysis center as part of a Quality Assurance/Continuous Quality Improvement program” and evaluated to look for trends toward decreases in flow in order to proactively identify access stenoses for expeditious referral for corrective procedures.¹

Transonic Hemodialysis Surveillance tracks a patient’s vascular access flow over time. Unlike other technologies that can only identify outflow stenoses in AV accesses, HD03 Monitor surveillance can detect a stenosis wherever it occurs within the vascular access circuit: inflow, outflow or between the needles in both fistulas or grafts. If access flow decreases below a critical threshold, fistulograms or interventions can be scheduled proactively to delay access failure. Such early intervention with minimally invasive restorative flow procedures reduces morbidity and costs.⁵ The clinic can continue to administer dialysis, collect and analyze data, and reduce its dependence on outside services for costly studies and lab tests.

References:

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1 National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Vascular Access 2006 Updates, http://www.kidney.org/professionals-/kdoqi/guideline_upHD_PDVA/va_guide4.htm.

2 European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), European Best Practice Guidelines on Haemodialysis: Guideline 5.2. Nephrol Dial Transplant 2007; 22(Suppl 2): ii99-ii100.

3 KHA-CARI Guideline: Vascular access ñ central venous catheters, arteriovenous fistulae and arteriovenous grafts. Polkinghorne KR, Chin GK, MacGinley RJ, Owen AR, Russell C, Talaulikar G, Vale E, Lopez-Vargas PA. Nephrology 2013; 18(11): 701-5.

4 Nesrallah GE et al, “Canadian Society of Nephrology guidelines for the management of patients with ESRD treated with intensive hemodialysis,” Am J Kidney Dis. 2013; 62(1): 187-98.

6 McCarley P et al, “Vascular Access Blood Flow Monitoring Reduces Access Morbidity and Costs,” Kidney Int 2001; 60(3): 1164-1172. (Transonic Reference # HD317A)