Kidney Week

Abstract: TH-PO267

Arteriovenous-Oscillometry to Assess Fistula Function

Session Information

• Vascular Access: From Biology to Managing Complications
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Vascular Access

Authors

• Busch, Veit, Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany

Veit Busch,

• Streis, Joachim, Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany

Joachim Streis,

• Mueller, Niklas, Klinikum der Universität München Medizinische Klinik und Poliklinik III, München, Bavaria, Germany

Niklas Mueller,

• Müller, Sandra, Technische Universitat Wien Institut fur Diskrete Mathematik und Geometrie, Wien, Wien, Austria

Sandra Müller,

• Seibert, Felix S., Marienhospital Herne Medizinische Klinik I Innere Medizin, Herne, Nordrhein-Westfalen, Germany

Felix S. Seibert,

• Felderhoff, Thomas, Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany

Thomas Felderhoff,

• Westhoff, Timm H., Marienhospital Herne Medizinische Klinik I Innere Medizin, Herne, Nordrhein-Westfalen, Germany

Timm H. Westhoff,

Background

We recently demonstrated that pulse wave analysis may be useful in functional fistula monitoring using tonometric measurement. We now aimed to evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min.

Methods

We recorded pulse waves ambilaterally with the vicorder® device at the brachial artery in 53 patients with native fistula and analyzed them with the use of a specifically developed matlab® application. The key parameters consisted of normalized variables assessed by the mean slope in the time sections between the footpoint, the systolic maximum (T1), the diacrotic notch, the first diastolic inflection point and the end of diastole: Specifically in the second section (slope2) and the sum of all four sections (slope∑). We furthermore assessed the amplitude of uncallibrated relative volumetric change in the measuring cuffs of the vicorder® device during cardiac cycle (AMP). Flow was measured with the use of duplex sonography.

Results

There were marked differences in the wave contours of the fistula and non-fistula side (Figure 1). Medians (fistula/non-fistula) of slope2, slope∑ and AMP were -0.00150/-0.00322 [relative amplitude/ms, p < 0.001], 0.01094/0.01187 [relative amplitude/ms, p=0.006] and 1850/725 [relative volumetric change, p< 0.001] (Wilcoxon test of related samples). T1 was delayed at the fistula arm (204 ± 3.4 ms versus 162 ± 5.3 ms at the non-fistula arm, p<0.001). ROC-analyses of parameter values measured at the fistula arm to detect low flow fistula demonstrated AUCs (with CI) of 0.652 (0.437-0.866, p=0.167) for slope2, 0.732 (0.566-0.899, p=0.006) for slope∑ and 0.775 (0.56-0.991, p=0.012) for AMP (Figure 2).

Conclusion

Fistula functional monitoring with oscillometry is feasible and is a promising clinical application to detect a low flow fistula.

Clinical characteristics

Exemplary pulse waves at the fistula and non-fistula arm of one patient before and after treatment of fistula-stenosis.