The overall purpose of this study is to compare the accuracy of physical examination (PE) versus ultrasonography (US) in people with arteriovenous fistula (AVF).
Methods
This is a cross-sectional study with a total of 99 patients attended by the vascular radiology unit for AVF evaluation during January - March 2015. PE and ultrasonography were blinded performed by different radiologists. For complete and individual signs of PE, sensitivity, specificity, predictive positive (PPV) and negative (PNV) value, likelihood ratios (LR) and Cohen's κ value were measured.
Results
According to ultrasonography, the presence of stenosis was identified in 57 (58%) patients, and 61 (62%) by PE. The accuracy of PE for the diagnosis of AVF was sensitivity 82%, specificity 67%, PPV 77%, NPV 74%, LR 2.74 and 0.26. There was a moderate agreement beyond chance between PE and ultrasonography (κ = 0.5).
Conclusions
PE has shown a moderate accuracy to detect stenosis. With non-ultrasonography availability Haemodialysis Units can get benefit to optimize VA survival and professionals should improve its basic skills.
LiyanageTNinomiyaTJhaVet al.Worldwide access to treatment for end-stage kidney disease: a systematic review.Lancet201538599811975–1982
3.
LiuKDChertowGMDiálisis en el tratamiento de la insuficiencia renal.In: Harrison ed. Principios de medicina interna 18th ed. Santa Fe, PA: McGraw-Hill interamericana editores20122812322
4.
GhonemyTAFaragSESolimanSAAminEMZidanAAVascular access complications and risk factors in hemodialysis patients: A single center study.Alexandria Journal of Medicine201652167–71
PirozziNGarcia-MedinaJHanoyMStenosis complicating vascular access for hemodialysis: indications for treatment.J Vasc Access201415276–82
8.
García MedinaJLacasa PérezNMuray CasesSPérez GarridoIGarcía MedinaV[Thrombosis in vascular accesses for haemodialysis: rescue treatment using invasive vascular radiological techniques].Nefrologia2009293249–255English version.
Jimenez AlmonacidPFistulas arteriovenosas para hemodiálisis.Nefrología al día201270
13.
KamperLFaizyTDHaagePDiagnosis and treatment of insufficient dialysis vascular access.Rofo20151875360–371
14.
CoentrãoLTurmel-RodriguesLMonitoring dialysis arteriovenous fistulae: it's in our hands.J Vasc Access2013143209–215
15.
MalovrhMPostoperative assessment of vascular access.J Vasc Access2014157 Suppl 7S10–S14
16.
La práctica de la medicina clínica.In: Harrison, ed. Principios de medicina interna 18th ed. Santa Fe, PA: McGraw-Hill interamericana editores 2012
17.
SalmanLBeathardGInterventional nephrology: Physical examination as a tool for surveillance for the hemodialysis arteriovenous access.Clin J Am Soc Nephrol2013871220–1227
18.
García-MedinaJMadureiraAMManejo clínico-ecográfico de las fístulas de hemodiálisis: breve manual práctico.1st ed. Murcia, PA: Diego Marín2015
19.
LandisJRKochGGThe measurement of observer agreement for categorical data.Biometrics1977331159–174
CamposRPChulaDCPerretoSRiellaMCdo NascimentoMMAccuracy of physical examination and intra-access pressure in the detection of stenosis in hemodialysis arteriovenous fistula.Semin Dial2008213269–273
22.
AsifALeonCOrozco-VargasLCet al.Accuracy of physical examination in the detection of arteriovenous fistula stenosis.Clin J Am Soc Nephrol2007261191–1194
23.
GroganJCastillaMLozanskiLGriffinALothFBassiounyHFrequency of critical stenosis in primary arteriovenous fistulae before hemodialysis access: should duplex ultrasound surveillance be the standard of care?J Vasc Surg20054161000–1006
24.
DoelmanCDuijmLELiemYSet al.Stenosis detection in failing hemodialysis access fistulas and grafts: comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance angiography, and digital subtraction angiography.J Vasc Surg2005424739–746
25.
LeonCAsifAPhysical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist?Semin Dial2008216557–560
26.
TessitoreNBedognaVMelilliEet al.In search of an optimal bedside screening program for arteriovenous fistula stenosis.Clin J Am Soc Nephrol201164819–826
