Dialysis – Transplantation
Kidney International (2001) 59, 2357–2360; doi:10.1046/j.1523-1755.2001.00753.x
Ultrasound dilution evaluation of pediatric hemodialysis vascular access
Stuart L Goldstein and Amelia Allsteadt
Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
Correspondence: Stuart L. Goldstein, M.D., Texas Children's Hospital, 6621 Fannin Street, MC 3-2482, Houston, Texas 77030, USA. E-mail: stuartg@bcm.tmc.edu
Received 24 August 2000; Revised 15 November 2000; Accepted 12 January 2001.
Abstract
Ultrasound dilution evaluation of pediatric hemodialysis vascular access.
Background
Hemodialysis access thrombosis is a significant cause of morbidity for hemodialysis patients and results from decreased access flow caused by venous outflow tract stenosis. Ultrasound dilution (UD) is a practical, noninvasive, and reliable indicator of access flow and is effective in predicting venous stenosis in adult patients receiving hemodialysis.
Methods
The current study is the first to our knowledge to evaluate the accuracy of UD in predicting hemodialysis access stenosis in a pediatric hemodialysis population. Thirteen pediatric patients receiving hemodialysis via permanent access (4 AVF and 9 AVG) received 73 UD measurements over three months.
Results
Mean raw access flow (QA) was 720 
428 mL/min, and mean corrected access flow (QAcorr) was 886 537 mL/min/1.73 m2. QAcorr was significantly lower in accesses with stenosis (401 176 mL/min/1.73 m2) versus accesses without stenosis (1158 330 mL/min/1.73 m2, P < 0.0001). Unlike flow values reported by raw QA, there was no overlap in flow values reported by QAcorr in accesses with stenosis (174 to 579 mL/min/1.73 m2) versus accesses without stenosis (709 to 1711 mL/min/1.73 m2). Two patients with an AVG who had QAcorr less than 600 mL/min/1.73 m2 developed an access thrombosis within one week after UD measurement. No patients with QAcorr greater than 700 mL/min/1.73 m2 developed access thrombosis in the 30 days following UD measurement.
Conclusions
The current study supports the use of monthly UD measurement to prevent access thrombosis in children receiving hemodialysis.
Keywords:
venogram, dialysis access, stenosis, blood flow, thrombosis, noninvasive measurement, children and dialysis
