Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jun 28, 2019; 8(3): 59-66
Published online Jun 28, 2019. doi: 10.5527/wjn.v8.i3.59
Static pressures, intra-access blood flow and dynamic Kt/V profiles in the prediction of dialysis access function
Abhilash Koratala, Bhagwan Dass, Kawther F Alquadan, Simrun Sharma, Girish Singhania, Abutaleb A Ejaz
Abhilash Koratala, Bhagwan Dass, Kawther F Alquadan, Simrun Sharma, Abutaleb A Ejaz, Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL 32610, United States
Girish Singhania, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT 84112, United States
Author contributions: Koratala A and Dass B have contributed equally to this work. Koratala A, Dass B and Ejaz AA designed research, drafted the manuscript; Koratala A, Dass B and Alquadan KF collected the data; Koratala A, Sharma S, Singhania G and Ejaz AA analyzed the data; Ejaz AA served as the mentor and critically reviewed and revised the manuscript.
Supported by the Gatorade Trust through funds distributed by the University of Florida, Division of Nephrology, Hypertension, and Renal Transplantation, Gainesville, FL [Awarded to Abhilash Koratala (Principal investigator), Abutaleb A Ejaz (Mentor)].
Institutional review board statement: The institutional review board of the University of Florida approved this study (IRB number 201702864). The procedures were performed in accordance with the Helsinki Declaration.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
STROBE statement: The STROBE statement has been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Abhilash Koratala, MD, Assistant Professor, Division of Nephrology, Hypertension and Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL 32610-0224, United States. abhilash.koratala@medicine.ufl.edu
Telephone: +1-352-273-8821 Fax: +1-352-392-3581
Received: December 14, 2018
Peer-review started: December 14, 2018
First decision: December 21, 2018
Revised: February 26, 2019
Accepted: March 27, 2019
Article in press: March 27, 2019
Published online: June 28, 2019
Abstract
BACKGROUND

Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. In our practice, we previously we observed that elevated static access pressures were associated with abnormal Kt/V values, high access recirculation and deviation of the Kt/V profile (Abnormal Kt/V profile) from normally expected values (Normal Kt/V profile).

AIM

To hypothesize that static or derived access pressures would correlate with direct intra-access blood flow rates and that clearance (Kt/V) profiles would correlate with measured Kt/V values.

METHODS

Static access pressures, real-time adequacy of dialysis and intra-access blood flow were investigated in end stage renal disease patients undergoing hemodialysis. Wilcoxon-Mann-Whitney test, chi-square test or Fisher’s exact test was used to investigate differences between the groups; Spearman’s rank correlation test to investigate relationships between static pressures, direct intra-access pressures and Kt/V profiles; and multinomial logistic regression models to identify the independent effect of selected variables on Kt/V profiles. Odds ratio were calculated to measure the association between the variables and Kt/V profiles.

RESULTS

One hundred and seven patients were included for analysis. There were no significant differences between genders, and types of vascular access between the normal vs. abnormal clearance (Kt/V) profile groups. No significant correlation could be demonstrated between static access pressures and Kt/V profiles, static access pressures and intra-access blood flow, intra-access blood flow and Kt/V profiles, measured Kt/V and Kt/V profiles or recirculation and Kt/V profiles.

CONCLUSION

In this study utilizing measured versus estimated data, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. These parameters, though useful estimates, cannot be accepted as quality assurance for dialysis adequacy or access function without further evidences.

Keywords: Static, Intra-access, Pressures, Hemodialysis, Kt/V

Core tip: Hemodialysis machine-generated circuit pressures and clearance profiles are potential predictors of quality assurances. We hypothesized that static or derived access pressures would correlate with direct intra-access blood flow rates and that Kt/V profiles would correlate with measured Kt/V values. However, we could not validate that dialysis machine generated elevated static pressures predict intra-access blood flow disturbances or that abnormal Kt/V profiles predict access recirculation or inadequate dialysis. While future larger studies are needed to confirm these findings, we believe our study serves as a basis for them.