SuO011DOPPLER ULTRASOUND VS TRANSONIC FOR ACCESS BLOOD FLOW BASED SURVEILLANCE. POST-HOC ANALYSIS FROM METTRO TRIAL. NCT02111655

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INTRODUCTION AND AIMS: Access blood flow (QA) based surveillance can reduce thrombosis and improve the autologous arteriovenous fistula (AVF) patency. There are direct and indirect ways for measuring QA but there is no evidence about which one is the best for be recommended as the gold standar technique for measuring QA. METHODS: We obtained 570 paired QA data, corresponding to 103 patients on prevalent hemodialysis program using an autologous AVF . These data were obtained by performing in the same day one QA measurement with Doppler ultrasonography (DU), which is a direct, observer dependent technique, and another QA measurement with Transonic ®, an indirect, observer independent technique. The DU measurement (QADU) was performed before the dialysis session and the Transonic measurement (QAT) was performed during the first hour of the same dialysis session. RESULTS: The mean QA was very similar for both techniques [QADU = 1357 ml / min [standard deviation (SD) 773 ml/min] and QAT = 1369 ml / min (SD 773 ml/min)]. The Pearson correlation coefficient was 0.605 and the intra-class correlation coefficient was 0,632.When we divide by groups of QA (Group 1.- QA 0-500 ml / min, Group 2- QA 501-1500 ml / min and Group 3.- QA higher than 1500 ml / min), we can see that QAT means are discreetly lower than QADU in group 1 and higher in group 3 but with no statistical significance. (table 1)If we take the QADU as a reference and we value the mean error of Transonic compared to DU, the mean error is only 11.7 ml/min but analyzing percentiles, the mean error is - 258 ml/min in percentile 25, -14,5 ml/min in percentile 50 and +281 ml/min in percentile 75.The error between the two measurements is much more pronounced in QA greater than 1500 ml / min, as can be seen in the Bland-Atltam plot. (Figure 1) CONCLUSIONS: There is a good intra-class correlation between DU and Transonic QA measurements but there is a different behavior of Transonic compared to DU in lower, medium and higher QA groups that has to be taken into account. The mean error between both techniques increases when QA is higher than 1500 ml/min.

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