Transonic Has Mixed Response to 2019 KDOQI Guidelines on Surveillance
By Susan Eymann, MS20 Jul 2020
The new 2019 KDOQI Guidelines emphasize that treatment for a hemodialysis patient be tailored to that individual patient. The Guidelines recommend that regular physical examinations or checks of the AVF or AVG by knowledgeable and experienced health practitioners be performed regularly to detect clinical indicators of flow dysfunction. However, this 2019 KDOQI modifies its position from prior guidelines with regard to vascular access surveillance (measuring flow, pressure monitoring or imaging for stenosis). The new guidelines state the following:
Surveillance to Facilitate Patency
“There is inadequate evidence for KDOQI to make a recommendation on routine AVF surveillance by measuring access blood flow, pressure monitoring or imaging for stenosis, that is additional to routine clinical monitoring to improve access patency. In other words, monitoring of vascular access is primary while surveillance findings are supplementary and action should not be based solely on surveillance findings”.
Transonic agrees wholeheartedly with the latter part of the statement, “surveillance findings are supplementary and action should not be based solely on surveillance findings.” Transonic measurements are and have always been supplementary and action to intervene on an vascular access should not be based solely on surveillance findings. Clinical indications and assessment, of which flow is simply one component, should always be considered by the nephrologist. Transonic also agrees that flow measurement surveillance doesn’t improve access patency on its own. It is simply an objective measurement tool that can guide a clinician’s decision making.
However, Transonic strongly disagrees with the first sentence that states that there is inadequate evidence to recommend the measurement of access blood flow. To the contrary, there is ample evidence in publications that Transonic flow measurements provide an objective number, in mLs/min of the flow inside an access and that flow can be trended over time to see if the access flow is decreasing due to a flow-limiting stenosis. Also, lumping various surveillance methods together, each of which have different (and occasionally very low) accuracy ranges and comparing them as if they are alike is unwise. Well validated and accurate Transonic access flow measurements should not be grouped with low accuracy BTM access flow measurements, or subjective pressure assessments or with imaging; these are all different technologies which should never be viewed in the same light.