Hemodynamic reproducibility during blood flow measurements of hemodialysis synthetic grafts

We have previously shown that graft blood flow (Qa) has a poor accuracy in predicting graft thrombosis. In this study, we determined whether hemodynamic variation helps explain this poor predictive accuracy. We also determined whether standardized timing of Qa measurements, which is widely recommended, will promote measurement reproducibility. We analyzed variations in mean arterial pressure (MAP) in seven consecutive dialysis sessions for 51 patients and determined the influence of MAP on Qa (by ultrasound dilution). We used a pooled coefficient of variation (CV) to summarize MAP variation within individual patients (computed as ±2 CVs). MAPs from the seven sessions varied widely, and most variation was present with the first MAPs at the beginning of the sessions. These first MAPs varied by ±23%, whereas variation for the entire session was ±28%. The influence of MAP on Qa was determined by measuring the two together during consecutive thirds of a single session. The percentage of change in MAP (ΔMAP) and Qa (ΔQa) from the first to middle or last thirds of the session varied over wide ranges: -37% to 86% and -43% to 78%, respectively. The ΔQa versus ΔMAP correlation was relatively strong for changes between the first and middle thirds (r = 0.666) and first and last thirds (r = 0.646) of the session (both P < 0.01). We conclude that MAP varies far more widely during dialysis than previously recognized. This variation is associated with large changes in Qa that may impair accuracy in predicting thrombosis. This wide MAP variation also indicates hemodynamic reproducibility is not feasible when measuring Qa. Thus, we do not recommend standardized timing of Qa measurements during dialysis. A practical method of addressing poor Qa reproducibility may be to take frequent measurements so that trends can be recognized before thrombosis occurs.