ESPN 50th Annual Meeting

ESPN 2017


 
Ultrasound Dilution and Thermodilution versus Color Doppler Ultrasound for Arteriovenous Fistula assessment in hemodialyzed children
VASILIKI KARAVA 1 THERESA KWON 1 JULIEN HOGAN 1 GILBERT FRANCO 2 GEORGES DESCHENES 1 MARIE-ALICE MACHER 1

1- Nephrology Department, Hôpital Robert-Debré, APHP, Paris, France
2- Clinique Arago, Paris
 
Introduction:

This study aims to compare ultrasound dilution (UD) and thermodilution with Color Doppler ultrasound (CDU), which is the most accurate method for AVF assessment in children on HD.

 

 

Material and methods:

All patients were dialyzed with the Fresenius 5008 HD machine. UD was performed using the Transonic device. The two methods were realised during the first 90 minutes of the same HD session and their results were compared to those acquired from the CDU performed in the same period in a non-HD weekly day.

 

Results:

Seventeen simultaneous measurements of AVF flow rate and recirculation with UD and thermodilution method and 17 CDU were realized in 16 patients with a median age of 14.5 and a median weight of 38.4 kg. The median AVF flow rate was 752 ml/min (range 387-2520) corrected to 1292 ml/min per 1.73m² (range 614-3893) with thermodilution, 810 ml/min (range 350-3250) corrected to 966 ml/min per 1.73 m² (range 513-3675) with UD method and 550 ml/min (range 310-2300) corrected to 750 ml/min per 1.73 m² (range 471-2601) according to the measurement of the CUD. A significant linear correlation was observed between AVF measured with UD method and CUD (r²=0.786, p<0.001) and between AVF measured with thermodilution and CUD (r²=0.232, p=0.05). AVF flow rate was higher with UD in comparison to CDU in 15 out of 17 cases and with thermodilution in comparison to CDU in 15 out of 17 cases as well. Whereas recirculation in all AVF was 0% and <15% with UD and thermodilution respectively, 8 significant stenosis were observed in CDU.

 

 

Conclusions:

Recirculation is not an accurate method for early screening of significant AVF stenosis in children on HD. UD seems more reliable in comparison to Thermodilution for AVF flow rate assessment. Both methods tend to overestimate AVF flow rate when compared to CDU.