Pressure profile analysis at hemodialysis needle: a new method for early detection of vascular access stenoses

Abstract

HEMODIALYSIS vascular access complications, such as thromboses due to flow limiting stenosis, are a major cause of morbidity and mortality in chronic renal failure patients [1, 2]. The Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines define a stenosis significant at 50 % diameter reduction, accompanied by a hemodynamic or clinical abnormality [1]. Since, flow limitation and pressure drop rise appear only at a diameter reduction above 70%, the current vascular access surveillance techniques (flow measurements and static-access pressure measurements) are unable to detect early stenosis (<50% diameter reduction) and cannot further reduce the incidence of vascular access failure due to thrombosis [3, 4]. To overcome the inability to predict early stage stenoses and the low sensitivity of current tests, a new, non-invasive method based on pressure profile analysis (PPA) was studied. Therefore, an in vitro model of a radio-cephalic arterio-venous fistula was built.