Observational study of surveillance based on the combination of online dialysance and thermodilution methods in hemodialysis patients with arteriovenous fistulas.

ABSTRACT

BACKGROUND/AIMS: Online dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs. This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared with a historic control group. METHODS: We studied 148 hemodialysis patients with arteriovenous fistulas (control group, n = 74) for 2 years. During the study period, the indications for vascular treatments were the Kt reduction ≥20% with respect to baseline values or Qa <500 ml/min (or a decrease in flow >20%). RESULTS: During the study period, we detected 16 cases of vascular dysfunction. The Kt value after vascular treatment was 71.1 liters (59 liters; p = 0.001) and BTM-Qa was 1,218.6 ml/min (519.7 ml/min; p = 0.001). Compared with the control group, the thrombosis rate was 0.027 versus 0.148 episodes/patient-year (p = 0.009) and the total access-related cost was EUR 22,293 versus 47,467 (p = 0.033). CONCLUSIONS: This study suggests that a combined monitoring program based on Kt and BTM-Qa represents an effective screening method that significantly reduces the thrombosis rate and economic costs of vascular treatments.