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Abstract
Introduction: Different first-generation methods exist for the detection of stenosis.
Objective: To determine the accuracy of first-generation methods in detecting stenosis in native arteriovenous fistulas.
Method: Retrospective observational study. Sample: Patients with functioning native arteriovenous fistulas. First-generation methods include physical examination, manual tests, pulse increase test and arm elevation test, indirect methods, Kt/V, and arteriovenous fistula recirculation. The diagnosis of stenosis was confirmed by Doppler ultrasound. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of first-generation methods based on Doppler ultrasound were calculated.
Results: Sample 39 patients, 79.48% male. Ultrasound detected 19 stenoses, nonsignificant. Physical examination: sensitivity 31.5%, specificity 80%, PPV 60%, NPV 55.1%, accuracy 56.4%. Pulse rise test: sensitivity 5.2%, specificity 90%, PPV 33.3%, NPV 50%, accuracy 48.7%. Arm elevation test: sensitivity 52.6%, specificity 70%, PPV 62.5%, NPV 60.8%, accuracy 61.5%. Indirect methods: sensitivity 15.7%, specificity 55%, PPV 25%, NPV 40.7%, accuracy 35.9%. Kt/V: sensitivity 10.5%, specificity 75%, PPV 28.5%, NPV 46.8%, accuracy 43.5%. AVF recirculation: sensitivity 10.5%, specificity 100%, PPV 100%, NPV 54.1%, accuracy 56.4%.
Conclusions: All first-generation methods have high specificity and low sensitivity. The degree of stenosis (significant or non-significant) could influence the sensitivity of the physical examination but not the specificity. The arm elevation test is the most accurate first-generation method of detecting stenosis.
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References
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- Armada E, Pérez-Melon C, Molina-Herrero J, Gayoso P, Camba M, Morcillo JE, et al. Programa de monitorización de accesos vasculares nativos para hemodiálisis. Nefrología. 2005;25(1):57-66.
- Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G , Martí -Monrós A, et al. Guía clínica española del acceso vascular para hemodiálisis. Nefrología. 2017;37:1-177. DOI: https://doi.org/10.1016/j.nefro.2017.11.004
- Besarab A. Access monitoring is worthwhile and valuable. Blood Purif. 2006;24:77-89. DOI: https://doi.org/10.1159/000089442
- Ibeas J. Monitorización del acceso vascular ¿Quo Vadis?. NefroPlus. 2011;4(2):1-56.
- Lok C, Huber T, Lee T, et al. KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular Access. Am J Kidney Dis. 2020;75(4)(Suppl2):S1-164. DOI: https://doi.org/10.1053/j.ajkd.2019.12.001
- Campos R, Chula D, Perreto S, Riella M, Do Nascimento M. Accuracy of physical examination and intra-access pressure in the detection of stenosis in hemodialysis arteriovenous fistula. Semin Dial. 2008;21:269-73. DOI: https://doi.org/10.1111/j.1525-139X.2007.00419.x
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- Rubio-Castañeda F, Fernández-Núñez M, Sierra-Sánchez A, Cantín-Lahoz V, Ferrer-López E, Mateo-Sánchez A. Influencia de las venas colaterales en la medición del flujo del acceso vascular mediante ecografía y termodilución: estudio observacional. Enfermería Nefrológica. 2022;25(4):330-6. DOI: https://doi.org/10.37551/52254-28842022033
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- Robbin M, Oser R, Lee J, Heudebert G, Mennemeyer S, Allon M. Randomized comparison of ultrasound surveillance and clinical monitoring on arteriovenous graft outcomes. Kidney Int. 2006;69:730-5. DOI: https://doi.org/10.1038/sj.ki.5000129
- León C, Orozco-Vargas L, Krishnamurthy G, Choi K, Mercado C, Merrill D, et al. Accuracy of physical examination in the detection of arteriovenous graft stenosis. Semin Dial. 2008;21:85-8. DOI: https://doi.org/10.1111/j.1525-139X.2007.00382.x
- Wang E, Schneditz D, Ronco C, Levin NW. Surveillance of fistula function by frequent recirculation measurements during high efficiency dialysis. ASAIO J. 2002;48:394-7. DOI: https://doi.org/10.1097/00002480-200207000-00012
- Fontseré N, Blasco M, Arias M, Maduell F, Vera M, Burrel M, et al. Is ionic dialysance useful for early detection of vascular access dysfunction? Six illustrative cases. Hemodialysis Int. 2011;15:108-11. DOI: https://doi.org/10.1111/j.1542-4758.2010.00501.x
References
Roca-Tey R. El acceso vascular para hemodiálisis: la asignatura pendiente. Nefrología. 2010;30(3):280-7.
Armada E, Pérez-Melon C, Molina-Herrero J, Gayoso P, Camba M, Morcillo JE, et al. Programa de monitorización de accesos vasculares nativos para hemodiálisis. Nefrología. 2005;25(1):57-66.
Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G , Martí -Monrós A, et al. Guía clínica española del acceso vascular para hemodiálisis. Nefrología. 2017;37:1-177. DOI: https://doi.org/10.1016/j.nefro.2017.11.004
Besarab A. Access monitoring is worthwhile and valuable. Blood Purif. 2006;24:77-89. DOI: https://doi.org/10.1159/000089442
Ibeas J. Monitorización del acceso vascular ¿Quo Vadis?. NefroPlus. 2011;4(2):1-56.
Lok C, Huber T, Lee T, et al. KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular Access. Am J Kidney Dis. 2020;75(4)(Suppl2):S1-164. DOI: https://doi.org/10.1053/j.ajkd.2019.12.001
Campos R, Chula D, Perreto S, Riella M, Do Nascimento M. Accuracy of physical examination and intra-access pressure in the detection of stenosis in hemodialysis arteriovenous fistula. Semin Dial. 2008;21:269-73. DOI: https://doi.org/10.1111/j.1525-139X.2007.00419.x
Ibeas J, Iglesias R, Merino J, Rubiela C, Vallespin J, Vinuesa X. Manual de ecografía para la exploración del acceso vascular. EDTNA/ERCA Madrid. 2019. Disponible en: https://www.edtnaerca.org/education/publications-sp
Ibeas J, Vallespin J. Ecografía del acceso vascular para hemodiálisis: conceptos teóricos y prácticos. Criterios. Nefrologia 2012;3(6):21-35.
Asif A, Leon C, Orozco-Vargas L, Krishnamurthy G, Choi K,Mercado C, et al. Accuracy of physical examination in the detection of arteriovenous fistula stenosis. Clin J Am Soc Nephrol. 2007;2:1191-4. DOI: https://doi.org/10.2215/CJN.02400607
Rodríguez-Cabrera MJ, Brunete-Mayor E, Torres-Máquez ML, García-Mauriño C, Fernández-Palacios V, Lorenzo-Ponce C. Validación de la dosis de diálisis medida con el monitor de aclaración en línea (OCM) y el Kt/V de Daugirdas ´93. Aplicación práctica en una unidad de hemodiálisis. Rev Soc Esp Enferm Nefrol. 2004;7(1):50-4. DOI: https://doi.org/10.4321/S1139-13752004000100005
Rubio-Castañeda F, Fernández-Núñez M, Sierra-Sánchez A, Cantín-Lahoz V, Ferrer-López E, Mateo-Sánchez A. Influencia de las venas colaterales en la medición del flujo del acceso vascular mediante ecografía y termodilución: estudio observacional. Enfermería Nefrológica. 2022;25(4):330-6. DOI: https://doi.org/10.37551/52254-28842022033
MedCalc Software Ltd. Diagnostic test evaluation calculator. [consultado 26 Jul 2023]. Disponible en: https://www.medcalc.org/calc/diagnostic_test.php 9.
Maya I, Oser R, Saddekni S, Barker J, Allon M. Vascular access stenosis: comparison of arteriovenous grafts and fistulas. Am J Kidney Dis. 2004;44:859-65. DOI: https://doi.org/10.1053/j.ajkd.2004.07.011
Robbin M, Oser R, Lee J, Heudebert G, Mennemeyer S, Allon M. Randomized comparison of ultrasound surveillance and clinical monitoring on arteriovenous graft outcomes. Kidney Int. 2006;69:730-5. DOI: https://doi.org/10.1038/sj.ki.5000129
León C, Orozco-Vargas L, Krishnamurthy G, Choi K, Mercado C, Merrill D, et al. Accuracy of physical examination in the detection of arteriovenous graft stenosis. Semin Dial. 2008;21:85-8. DOI: https://doi.org/10.1111/j.1525-139X.2007.00382.x
Wang E, Schneditz D, Ronco C, Levin NW. Surveillance of fistula function by frequent recirculation measurements during high efficiency dialysis. ASAIO J. 2002;48:394-7. DOI: https://doi.org/10.1097/00002480-200207000-00012
Fontseré N, Blasco M, Arias M, Maduell F, Vera M, Burrel M, et al. Is ionic dialysance useful for early detection of vascular access dysfunction? Six illustrative cases. Hemodialysis Int. 2011;15:108-11. DOI: https://doi.org/10.1111/j.1542-4758.2010.00501.x