Glucose Pump Technique is as Good as Ultrasound Dilution Technique for Vascular Access Surveillance in Hemodialysis Patients

Korean Journal of Nephrology 2007;26(4):448-454.

Sang Jin Ha, M.D.1, Yoon Jung Lee, M.D.1, Byung Hyun Cho, M.D.1, Kyung-Hwan Jung, M.D.1, Joo-Yung Moon, M.D.2, Sang-Ho Lee, M.D.2, Tae-Won Lee, M.D.1, and Chun-Gyoo Ihm, M.D.1

Department of Nephrology¹
College of Medicine, Kyunghee University, Seoul, Korea; Department of Nephrology²
Kyunghee East West Neo Medical Center, Seoul, Korea

혈액 투석 환자에서 포도당 희석법과 초음파 희석법을 이용한 혈관 통로의 혈류 속도 비교

하상진1

경희대학교 의과대학 부속병원 신장내과1, 경희대학교 동서신의학병원 신장내과2

Abstract

Purpose
: Vascular access flow (Qa) measurements are important in the surveillance protocol of hemodialysis vascular access stenosis. The glucose pump technique (GPT) is a technique for Qa measurement based on the dilution technique of a constant glucose infusion that was introduced in 1995. The aim of this study is to verify the clinical efficacy of GPT in vascular access surveillance compared with ultrasound dilution technique.
Methods
: In 31 chronic hemodialysis patients with a AV fistula, we compared Qa measurements performed with GPT in pre-dialysis and the ultrasound dilution technique (Transonic HD01, Transonic System Inc., Ithaca, NY) during hemodialysis.
Results
: Mean Qa was 1171 ml/min by GPT versus 1028 ml/min by HD01 (p=0.262). There was a strong linear correlation between the two methods (r=0.61; p<0.01). Ultrasound dilution technique HD01 yielded 6 cases of high risk Qa measurements and GPT yielded 4 cases of high risk Qa measurements. The diagnostic accuracy of GPT tested with the ROC curve was similar with ultrasound dilution technique HD01. The specificity and sensitivity was 80% and 66.7% according to Qa=600 ml/min. But sensitivity was 83.3% according to Qa=750 ml/min.
Conclusion
: GPT offers the advantage of a simple and economic bedside procedure easily performed before dialysis and had a similar diagnostic accuracy and efficiency compared with ultrasound dilution technique HD01.

Key Words: Stenosis, Hemodialysis, Dilution technique