#3826 Comparison of pre- and post-dialysis vascular access flow measurements: implications for monitoring strategies

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Abstract Background and Aims Vascular access monitoring is crucial in the management of patients on hemodialysis, and vascular access flow (Qa) plays a key role in monitoring its function. Guidelines recommend that Qa measurement be performed under hemodynamically stable conditions to ensure greater accuracy of the results. Due to variations in blood volume and intravascular pressure during dialysis, the literature frequently suggests that Qa measurement should occur before the start of the hemodialysis session. However, studies directly comparing measurements taken before and after dialysis are insufficient. The objective of our study was to compare the pre- and post-dialysis Qa in patients from a hospital-based hemodialysis program. Method Patients from a hemodialysis program at a hospital center were selected, and Qa measurements were taken both before and after hemodialysis. Flow measurements were performed pre and post hemodialysis by the same professional. Results A total of 40 patients were included in the study, with a mean age of 63.93 ± 16.10 years. Among them, 21 were male (52.5%). Regarding vascular access, 15 patients had a humerocephalic arteriovenous fistula, 10 had a radiocephalic fistula, 7 had a humerobasilic fistula, 7 had an arteriovenous graft, and 1 had a humerohumeral AVF. The majority (n = 25, 62.5%) were undergoing hemodiafiltration. The most common etiology of kidney disease was glomerular (n = 11, 27.5%), followed by an undetermined cause (n = 9, 22.5%) and diabetic kidney disease (n = 7, 17.5%). Hypertension was highly prevalent (n = 38, 95%), as were diabetes (n = 27, 67.5%) and documented atherosclerotic disease (n = 29, 72.5%). The mean of the three Qa measurements taken before hemodialysis was 1249.04 ± 410.29 mL/min, while the mean after hemodialysis was 1190.00 ± 401.83 mL/min, showing a significant reduction post-hemodialysis, as indicated by the paired t-test (t (39) = 5.837, P < 0.001, 95% CI [34.01, 70.07]). Conclusion As supported by existing literature, our study confirms a statistically significant reduction in Qa after hemodialysis. However, from a clinical standpoint, the mean difference before and after hemodialysis is only 59 mL/min, a change that is often not meaningful in vascular access assessment. While variations in intravascular volume and pressure can influence vascular access flow, their clinical relevance remains uncertain despite statistical significance. Larger studies are needed to determine whether post-hemodialysis Qa measurement could serve as a reliable monitoring strategy.

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