Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula
Abstract Background Pulse wave analysis may be useful to assess fistula function. We aimed to prospectively evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min in a real life clinical setting. Methods Pulse waves were recorded ambilaterally with the vicorder®...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-023-03243-w |
| _version_ | 1797795799311056896 |
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| author | Veit Busch Joachim Streis Sandra Müller Niklas Mueller Felix S. Seibert Thomas Felderhoff Timm H. Westhoff |
| author_facet | Veit Busch Joachim Streis Sandra Müller Niklas Mueller Felix S. Seibert Thomas Felderhoff Timm H. Westhoff |
| author_sort | Veit Busch |
| collection | DOAJ |
| description | Abstract Background Pulse wave analysis may be useful to assess fistula function. We aimed to prospectively evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min in a real life clinical setting. Methods Pulse waves were recorded ambilaterally with the vicorder® device at the brachial artery in 53 patients on haemodialysis with native fistula. Primary variables consisted of the mean slope between the systolic maximum and the diacrotic notch (Slope2), the sum of the mean slopes in the four characteristic sections of pulse waves (Slope∑) and the amplitude of relative volumetric change in the measuring cuff at the upper arm (AMP). Fistula flow was measured with the use of duplex sonography using a standardized approach. Results Parameter values above or below the median indicated measurement at the non-fistula side, with sensitivities/specificities of 0.79/0.79 (p < 0.001) for Slope 2, 0.64/0.64 (p = 0.003) for Slope∑ and 0.81/0.81 (p < 0.001) for AMP if measurements at the fistula and non-fistula arm were considered. ROC-analyses of parameter values measured at the fistula to detect low flow demonstrated AUCs (with CI) of 0.652 (0.437–0.866, p = 0.167) for Slope2, 0.732 (0.566–0.899, p = 0.006) for Slope∑ and 0.775 (0.56–0.991, p = 0.012) for AMP. The point with maximal youden’s index was regarded as optimal cut-off, which corresponded to sensitivities and specificities of 0.8/0.56 for slope2, 0.86/ 0.56 for Slope∑ and 0.93/0.78 for AMP. Conclusion Functional surveillance with oscillometry is a promising clinical application to detect a low fistula flow. Among all investigated pulse wave parameters AMP revealed the highest diagnostic accuracy. Graphical Abstract |
| first_indexed | 2024-03-13T03:23:29Z |
| format | Article |
| id | doaj.art-b57e480fa5244464bfbab5329a189b75 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-03-13T03:23:29Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-b57e480fa5244464bfbab5329a189b752023-06-25T11:11:25ZengBMCBMC Nephrology1471-23692023-06-0124111110.1186/s12882-023-03243-wOscillometric pulse wave analysis for detecting low flow arteriovenous fistulaVeit Busch0Joachim Streis1Sandra Müller2Niklas Mueller3Felix S. Seibert4Thomas Felderhoff5Timm H. Westhoff6NephrovitalPleiger Maschinenbau GmbH & Co KGTechnische Universität Wien Institut für Diskrete Mathematik und GeometrieKlinikum der Universität München, Medizinische Klinik und Poliklinik IIIDepartment of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University BochumFachhochschule DortmundDepartment of Internal Medicine I, University Hospital Marien Hospital Herne, Ruhr-University BochumAbstract Background Pulse wave analysis may be useful to assess fistula function. We aimed to prospectively evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min in a real life clinical setting. Methods Pulse waves were recorded ambilaterally with the vicorder® device at the brachial artery in 53 patients on haemodialysis with native fistula. Primary variables consisted of the mean slope between the systolic maximum and the diacrotic notch (Slope2), the sum of the mean slopes in the four characteristic sections of pulse waves (Slope∑) and the amplitude of relative volumetric change in the measuring cuff at the upper arm (AMP). Fistula flow was measured with the use of duplex sonography using a standardized approach. Results Parameter values above or below the median indicated measurement at the non-fistula side, with sensitivities/specificities of 0.79/0.79 (p < 0.001) for Slope 2, 0.64/0.64 (p = 0.003) for Slope∑ and 0.81/0.81 (p < 0.001) for AMP if measurements at the fistula and non-fistula arm were considered. ROC-analyses of parameter values measured at the fistula to detect low flow demonstrated AUCs (with CI) of 0.652 (0.437–0.866, p = 0.167) for Slope2, 0.732 (0.566–0.899, p = 0.006) for Slope∑ and 0.775 (0.56–0.991, p = 0.012) for AMP. The point with maximal youden’s index was regarded as optimal cut-off, which corresponded to sensitivities and specificities of 0.8/0.56 for slope2, 0.86/ 0.56 for Slope∑ and 0.93/0.78 for AMP. Conclusion Functional surveillance with oscillometry is a promising clinical application to detect a low fistula flow. Among all investigated pulse wave parameters AMP revealed the highest diagnostic accuracy. Graphical Abstracthttps://doi.org/10.1186/s12882-023-03243-wPulse wave analysisHaemodialysis, arteriovenous fistulaDuplex sonography |
| spellingShingle | Veit Busch Joachim Streis Sandra Müller Niklas Mueller Felix S. Seibert Thomas Felderhoff Timm H. Westhoff Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula BMC Nephrology Pulse wave analysis Haemodialysis, arteriovenous fistula Duplex sonography |
| title | Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula |
| title_full | Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula |
| title_fullStr | Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula |
| title_full_unstemmed | Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula |
| title_short | Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula |
| title_sort | oscillometric pulse wave analysis for detecting low flow arteriovenous fistula |
| topic | Pulse wave analysis Haemodialysis, arteriovenous fistula Duplex sonography |
| url | https://doi.org/10.1186/s12882-023-03243-w |
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