Monitoring interposition graft venous pressures at higher blood-flow rates improves sensitivity in predicting graft failure

Rajiv Agarwal, J. L. Davis

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Monitoring the patency of hemodialysis interposition grafts is recommended to improve graft survival. Which blood flows best predict graft survival is not known. We monitored venous pressures in 32 dialysis patients over a median of 252 days at variable flow rates of the blood pump (Qb). Venous pressure trends (VPTs), maximum venous pressure (MVP), and the variability of venous pressure (percent coefficient of variation) were calculated. Kaplan-Meier curves were constructed from the time of the end of VPT monitoring to time to failure, defined as angioplasty, clotting, or surgical revision. Risk for graft failure for each 10-mm Hg increase in venous pressure was calculated by the Cox proportional hazards model. There were 12 graft failures, but no failures in 12 fistulas over the course of the study. The variability in venous pressure was less at greater Qbs. For grafts, VPTs were predictive of event only when calculated for Qbs greater than 100 mL/min. At Qbs of 400 mL/min, there was a 70% risk for graft failure with each 10-mm Hg increase in VPT. The risk for graft failure increased between 28% and 44% for each 10-mm Hg increase in MVP at all Qbs. MVP of 230 mm Hg at a Qb of 400 mL/min provided the best efficiency of test performance. Dialysis venous chamber pressure monitoring is a useful test to predict graft stenosis or thrombosis. There is a substantial variability in venous pressures in the same patient that reduces with increasing Qbs. Venous pressure monitoring at greater Qbs provides a more sensitive method for predicting access failure.

Original languageEnglish
Pages (from-to)212-217
Number of pages6
JournalAmerican Journal of Kidney Diseases
Volume34
Issue number2
StatePublished - 1999

Fingerprint

Venous Pressure
Transplants
Graft Survival
Dialysis
Reoperation
Angioplasty
Proportional Hazards Models
Fistula
Renal Dialysis

Keywords

  • Angioaccess
  • Hemodialysis
  • Monitoring
  • Survival

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{4350cbebbd8a47e5947d710a38aafd2f,
title = "Monitoring interposition graft venous pressures at higher blood-flow rates improves sensitivity in predicting graft failure",
abstract = "Monitoring the patency of hemodialysis interposition grafts is recommended to improve graft survival. Which blood flows best predict graft survival is not known. We monitored venous pressures in 32 dialysis patients over a median of 252 days at variable flow rates of the blood pump (Qb). Venous pressure trends (VPTs), maximum venous pressure (MVP), and the variability of venous pressure (percent coefficient of variation) were calculated. Kaplan-Meier curves were constructed from the time of the end of VPT monitoring to time to failure, defined as angioplasty, clotting, or surgical revision. Risk for graft failure for each 10-mm Hg increase in venous pressure was calculated by the Cox proportional hazards model. There were 12 graft failures, but no failures in 12 fistulas over the course of the study. The variability in venous pressure was less at greater Qbs. For grafts, VPTs were predictive of event only when calculated for Qbs greater than 100 mL/min. At Qbs of 400 mL/min, there was a 70{\%} risk for graft failure with each 10-mm Hg increase in VPT. The risk for graft failure increased between 28{\%} and 44{\%} for each 10-mm Hg increase in MVP at all Qbs. MVP of 230 mm Hg at a Qb of 400 mL/min provided the best efficiency of test performance. Dialysis venous chamber pressure monitoring is a useful test to predict graft stenosis or thrombosis. There is a substantial variability in venous pressures in the same patient that reduces with increasing Qbs. Venous pressure monitoring at greater Qbs provides a more sensitive method for predicting access failure.",
keywords = "Angioaccess, Hemodialysis, Monitoring, Survival",
author = "Rajiv Agarwal and Davis, {J. L.}",
year = "1999",
language = "English",
volume = "34",
pages = "212--217",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Monitoring interposition graft venous pressures at higher blood-flow rates improves sensitivity in predicting graft failure

AU - Agarwal, Rajiv

AU - Davis, J. L.

PY - 1999

Y1 - 1999

N2 - Monitoring the patency of hemodialysis interposition grafts is recommended to improve graft survival. Which blood flows best predict graft survival is not known. We monitored venous pressures in 32 dialysis patients over a median of 252 days at variable flow rates of the blood pump (Qb). Venous pressure trends (VPTs), maximum venous pressure (MVP), and the variability of venous pressure (percent coefficient of variation) were calculated. Kaplan-Meier curves were constructed from the time of the end of VPT monitoring to time to failure, defined as angioplasty, clotting, or surgical revision. Risk for graft failure for each 10-mm Hg increase in venous pressure was calculated by the Cox proportional hazards model. There were 12 graft failures, but no failures in 12 fistulas over the course of the study. The variability in venous pressure was less at greater Qbs. For grafts, VPTs were predictive of event only when calculated for Qbs greater than 100 mL/min. At Qbs of 400 mL/min, there was a 70% risk for graft failure with each 10-mm Hg increase in VPT. The risk for graft failure increased between 28% and 44% for each 10-mm Hg increase in MVP at all Qbs. MVP of 230 mm Hg at a Qb of 400 mL/min provided the best efficiency of test performance. Dialysis venous chamber pressure monitoring is a useful test to predict graft stenosis or thrombosis. There is a substantial variability in venous pressures in the same patient that reduces with increasing Qbs. Venous pressure monitoring at greater Qbs provides a more sensitive method for predicting access failure.

AB - Monitoring the patency of hemodialysis interposition grafts is recommended to improve graft survival. Which blood flows best predict graft survival is not known. We monitored venous pressures in 32 dialysis patients over a median of 252 days at variable flow rates of the blood pump (Qb). Venous pressure trends (VPTs), maximum venous pressure (MVP), and the variability of venous pressure (percent coefficient of variation) were calculated. Kaplan-Meier curves were constructed from the time of the end of VPT monitoring to time to failure, defined as angioplasty, clotting, or surgical revision. Risk for graft failure for each 10-mm Hg increase in venous pressure was calculated by the Cox proportional hazards model. There were 12 graft failures, but no failures in 12 fistulas over the course of the study. The variability in venous pressure was less at greater Qbs. For grafts, VPTs were predictive of event only when calculated for Qbs greater than 100 mL/min. At Qbs of 400 mL/min, there was a 70% risk for graft failure with each 10-mm Hg increase in VPT. The risk for graft failure increased between 28% and 44% for each 10-mm Hg increase in MVP at all Qbs. MVP of 230 mm Hg at a Qb of 400 mL/min provided the best efficiency of test performance. Dialysis venous chamber pressure monitoring is a useful test to predict graft stenosis or thrombosis. There is a substantial variability in venous pressures in the same patient that reduces with increasing Qbs. Venous pressure monitoring at greater Qbs provides a more sensitive method for predicting access failure.

KW - Angioaccess

KW - Hemodialysis

KW - Monitoring

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=0032815304&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032815304&partnerID=8YFLogxK

M3 - Article

C2 - 10430964

AN - SCOPUS:0032815304

VL - 34

SP - 212

EP - 217

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 2

ER -