How to Reduce the Risk of Arteriovenous Fistula Dysfunction by Observing Prepump Arterial Pressure during Hemodialysis: A Multicenter Retrospective Study.

Publisher: S. Karger Country of Publication: Switzerland NLM ID: 8402040 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1421-9735 (Electronic) Linking ISSN: 02535068 NLM ISO Abbreviation: Blood Purif Subsets: MEDLINE

Original Publication: Basel ; New York : S. Karger, [c1983-

Arterial Pressure*; Arteriovenous Fistula/*etiology ; Renal Dialysis/*adverse effects; Adult ; Aged ; Arteriovenous Fistula/physiopathology ; Arteriovenous Fistula/prevention & control ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk ; Risk Factors

Objective: Prepump arterial (Pa) pressure indicates the ease or difficulty with which the blood pump can draw blood from the vascular access (VA) during hemodialysis. Some studies have suggested that the absolute value of the Pa pressure to the extracorporeal blood pump flow (Qb) ratio set on the machine (|Pa/Qb|) can reflect the dysfunction of VA. This study was conducted to explore the impact of arteriovenous fistula (AVF) dysfunction and to explore the clinical reference value of |Pa/Qb|.
Methods: We retrospectively identified adults who underwent hemodialysis at 3 hospitals. Data were acquired from electronic health records. We evaluated the pattern of the association between |Pa/Qb| and AVF dysfunction during 1 year using a Cox proportional hazards regression model with restricted cubic splines. Then, the patients were grouped based on the results, and hazard ratios were compared for different intervals of |Pa/Qb|.
Results: A total of 490 patients were analyzed, with an average age of 55 (44, 66) years. There were a total of 85 cases of AVF dysfunction, of which 50 cases were stenosis and 35 cases were thrombosis. There was a U-shaped association between |Pa/Qb| and the risk of AVF dysfunction (p for nonlinearity <0.001). |Pa/Qb| values <0.30 and >0.52 increased the risk of AVF dysfunction. Compared with the group with a |Pa/Qb| value between 0.30 and 0.52, the groups with |Pa/Qb| <0.30 and |Pa/Qb| >0.52 had a 4.04-fold (p = 0.002) and 3.41-fold (p < 0.001) greater risk of AVF dysfunction, respectively.
Conclusions: The appropriate range of |Pa/Qb| is between 0.30 and 0.52. When |Pa/Qb| is <0.30 or >0.52, the patient's AVF function or Qb setting should be reevaluated to prevent subsequent failure.
(© 2021 S. Karger AG, Basel.)

Keywords: Arteriovenous fistula; Blood flow rate; Hemodialysis nursing; Prepump arterial pressure

Date Created: 20210202 Date Completed: 20220120 Latest Revision: 20220120

20231215

10.1159/000512352

33530090