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
Processing time: 196 Days and 12.1 Hours
ARTICLE HIGHLIGHTS
Research background

The monitoring of dialysate ultraviolet absorbance and hemodialysis machine generated clearance profiles is a validated technology to measure dialysis adequacy (Kt/V) and allows for continuous and real-time tracking during each session. The Kt/V profile displayed by the machine includes the delivered-dose curve superimposed on the anticipated trajectory.

Research motivation

In our practice, we noted that 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).

Research objectives

Based on the above observation, we hypothesized that static or derived access pressures would correlate with intra-access blood flow rates and that clearance (Kt/V) profiles would correlate with measured Kt/V values.

Research methods

We investigated static access pressures, real-time adequacy of dialysis and intra-access blood flow in patients undergoing hemodialysis. Appropriate statistical methods were used to investigate differences between the groups; relationships between static pressures, direct intra-access pressures and Kt/V profiles; and 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.

Research results

Among the 107 participants included, 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.

Research conclusions

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.

Research perspectives

The investigated hemodialysis machine-generated parameters and access flows, though useful estimates can’t be accepted as quality assurance for dialysis adequacy or access function without further evidences. Larger studies are needed to formulate protocol-driven modifications to treatment parameters, which may serve as valuable nursing tools for optimizing patient therapy outcomes.