Nephrology Dialysis Transplantation, Vol 13, Issue 1 118-124, Copyright © 1998 by Oxford University Press
W Paulson, M Gadallah, B Bieber, S Altman, C Birk and J Work
Background: There is wide disagreement among studies
that have evaluated the accuracy of urea recirculation (UR) in detecting
vascular access stenosis. The 3-site method (UR3) has been discredited and
replaced by the 2-site method (UR2), but few studies have evaluated UR2.
Methods: We compared the accuracies of UR2 and UR3 in
detecting stenosis in 59 haemodialysis patients during a 12-month period.
All patients were studied without regard to clinical suspicion of stenosis.
Stenosis (⩾50% luminal narrowing) was diagnosed by duplex
ultrasound and confirmed by angiography. The reproducibility of UR2 was
determined by computing its total standard deviation (SDTOT) from
measurements during three dialysis sessions over a 15-day period.
Results: Stenosis was found in 32% of 124 access
studies (mean luminal narrowing=58%, range=50-83%). The mean UR values of
stenotic accesses were only slightly higher than nonstenotic accesses for
both UR2 (7.6% vs 2.9%, P <0.01) and UR3 (13.1%
vs 11.2%, P=0.22). An increase in blood pump speed
from 300 to 425 ml/min did not improve detection of stenosis by UR2. There
were no UR thresholds that cold adequately separate the presence of
stenosis from its absence. The SDTOT of UR2 was 3.8%, indicating that a
patient's UR2 measurement may vary over a range of 16%
(±2SDTOT=±8%). Conclusion:
Stenosis of the haemodialysis access does not predictably cause
recirculation, and the reproducibility of the UR2 measurement is poor.
Key words: blood urea nitrogen; blood-vessel
prosthesis; dialysis; recirculation; ultrasonography; vascular patency
ORIGINAL ARTICLES
Accuracy and reproducibility of urea recirculation in detecting haemodialysis access stenosis
Section of Nephrology and Hypertension, Department of Medicine, Louisiana State University Medical Center, PO Boc 33932, Shreveport, LA 71130, USA; Open Access Sonography, Inc., Boc Raton, FL, USA; Corresponding author
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