The effect of erythropoietin treatment on arteriovenous haemodialysis fistula/graft: A prospective study with colour flow doppler ultrasonography

Abstract

To determine the effect of erythropoietin (EPO) on patency the haemodynamics and morphology in haemodialysis fistula/graft were prospectively assessed using ultrasonographic two-dimensional imaging and colour flow Doppler together with pulsed Doppler, prior to and during partial correction of anaemia with EPO. Nineteen radiocephalic fistula and 11 loop grafts in 30 patients on routine maintenance haemodialysis were investigated prior to EPO treatment. A significant stenosis defined as a localised 100% increase in flow velocity was found in the arterial inflow in seven (23%) patients, in the loop graft in seven (64% of loop grafts) patients, and in the venous segments in 23 (77%) patients. Fourteen patients were rescanned after more than 200 days of EPO therapy. There was a significant increase in haemoglobin (84 +/- 14 g/l to 104 +/- 18 g/l) and haematocrit (24 +/- 4 to 31 +/- 5%) during this time. One arterial, four loop grafts and two venous stenoses appeared or increased in severity, and one venous return flow segment had occluded. Blood flow according to ultrasonography was unchanged. Of the 16 patients lost to follow-up, three underwent surgical intervention (clinical failure rate 0.20 access/year). EPO therapy may contribute to minor changes in access haemodynamics but does not seem to be detrimental to patency.