Can we evaluate hemodialysis access blood flow by ultrasonography during dialysis?

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  • 超音波検査による内シャント血流機能評価は「透析中」でも実施可能か？
  • チョウオンパ ケンサ ニ ヨル ナイ シャント ケツリュウ キノウ ヒョウカ ワ 「 トウセキ チュウ 」 デモ ジッシ カノウ カ?

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Abstract

If we become able to perform arteriovenous (AV) fistula ultrasonography during dialysis, we will be able to evaluate the hemodialysis access more effectively. In this study, we investigated whether we could perform an accurate hemodialysis access flow usability test by employing ultrasonography during dialysis. The study subjects were 62 maintenance hemodialysis patients. During dialysis, we measured the AV fistula blood flow volume (FV) and AV fistula vascular resistance index (RI) of the brachial artery. The measurements were made when the blood pump was (PO) and was not (DNPO) operating, respectively. First, correlation analysis was conducted to evaluate the relationships between PO-FV and DNPO-FV, between PO-RI and DNPO-RI, between PO-FV and DNPO-FV under the condition of less than FV 350 mL/min, between PO-RI and DNPO-RI under the condition of less than FV 350 mL/min, between PO-FV and DNPO-FV under the condition of more than RI 0.6, and between PO-RI and DNPO-RI under the condition of more than RI 0.6. Subsequently, we compared the changes in the mean FV and RI over time. We also compared the brachial artery depiction rate and standard deviation (SD) of FV SD among AV fistula parts：brachium, elbow, and antebrachium. The total number of measurements for FV and RI was 992 times each. Significant positive correlations between PO and DNPO were shown in both FV and RI. Also, even in the case of a low flow of less than 350 mL/min, FV and RI showed significant positive correlations between PO and DNPO. In the case of more than RI 0.6, FV showed a significant positive correlation between PO and DNPO, while RI did not show a significant correlation between them. Furthermore, as for the mean value in each elapsed time of PO and DNPO, neither FV nor RI showed a significant difference. On evaluation of the measured parts, SD of FV in the upper arm part was greater than in the antebrachium and elbow, and the brachial artery depiction rate in the upper arm was low. These results indicate that we can perform an accurate AV fistula blood flow usability test during dialysis regardless of PO and DNPO in the antebrachium and elbow.

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