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Nephrol Dial Transplant (2001) 16: 395-399
© 2001 European Renal Association-European Dialysis and Transplant Association

Technical Note

Flow measurements in dialysis shunts: lack of agreement between conventional Doppler, CVI-Q, and ultrasound dilution

Adriaan L. Zanen,1, Irwin M. Toonder2, Eunice Korten2, Cees H. A. Wittens3 and Philip P. N. M. Diderich1

1 Departments of Nephrology 2 Vascular Investigation 3 Vascular Surgery, St Franciscus Gasthuis, Rotterdam, The Netherlands

Abstract

Background. Measuring flow in dialysis shunts is recommended to predict imminent thrombosis. Multiple methods for measuring blood flow are in use. Numerous ultrasound protocols exist which determine volume flow using a conventional Doppler (CD) frequency shift analysis technique. All of these are subject to potentially large errors. Quantitative colour velocity index (CVI-Q) does not make use of the Doppler equation and is more precise in vitro. Ultrasound dilution (UD) measures access flow during dialysis in a non-operator-dependent way. The aim of the present study was to compare these three methods of measuring access flow in vivo for agreement with each other.

Methods. In 38 accesses flow was measured by CD, CVI-Q, and UD. All measurements were done during dialysis. Agreement was determined by intraclass correlation coefficient (ICC=Ri) and Bland–Altman analysis.

Results. ICC between UD and CVI-Q was Ri=0.56. ICC between UD and CD was Ri=0.10, and ICC between CD and CVI-Q was Ri=0.16. Bland–Altman analysis revealed a bias (mean difference) of -38 ml/min between UD and CVI-Q, a bias of 1129 ml/min between UD and CD, and a bias of 1167 ml/min between CVI-Q and CD.

Conclusions. CD measurements did not agree with UD or CVI-Q: much higher values were recorded with the former than with the latter two techniques. The agreement between UD and CVI-Q measurements is low but reasonable. Caution must be applied in comparing and interpreting values of access flow measured by different techniques.

Keywords: arteriovenous shunt; blood flow velocity; CVI-Q; haemodialysis; ultrasonography; ultrasound dilution

Notes

Correspondence and offprint requests to: A. L. Zanen, Department of Nephrology, Academisch Ziekenhuis Dijkzigt, Dr Molewaterplein 40, PO Box 2040, 3000 CA Rotterdam, The Netherlands.


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