Changes in vascular access blood flow: Etiological factors and clinical implications

Abstract

Changes in access blood flow (QVA) are of utmost importance in vascular access (VA) management when deciding on VA referral for an intervention. The article elucidates impact of different factors on QVA changes. Methods: Records of 10,000 QVA measurement performed in 549 patients over 20 years were used as retrospective and anonymized data source, making ethical commission involvement unnecessary. Two approaches are used to elucidate association of QVA changes with different factors: analyses of smaller cohorts in which both the QVA and the respective factor were measured (e.g. association of QVA with cardiac output (CO)), or—in case of rare phenomena—a form of a well illustrated case reports was used (e.g. association of QVA and Kt/V). Results: Significant increase in CO after permanent VA creation (3-4-fold of the QVA value) was found. Impact of intradialytic CO changes on QVA is attenuated by relatively stable VA resistance compared to systemic resistance. Blood pressure impact is much stronger and it should therefore be noted at each QVA measurement. As reproducibility of different QVA measurement methods varies, use of the same method should be preferred. Direction of the arterial needle insertion in VA affects the QVA measured, especially in synthetic grafts, too. Also patient’s own QVA variability may be quite high. All this makes KDOQI/EBPG recommended acceptable QVA drops too strict, they should be revised. In re-stenoses prone patients, measurement intervals should be shortened, too. Conclusion: QVA values are significantly affected by many factors. Their knowledge appears essential for safe and effective VA surveillance and management.