Accuracy of doppler ultrasonography in the evaluation of hemodialysis arteriovenous fistula maturity

OBJECTIVE:
to determine the accuracy of Doppler ultrasonography (USD) for hemodialysis arteriovenous fistula (AVF) maturity.
METHODS: we included patients with no prior AVF. Each patient underwent two USD examinations. After initiation of hemodialysis, we followed the patients during the first month of the access use and verified its adequacy to hemodialysis sessions. At statistical analysis we measured specificity, sensitivity, accuracy, ROC curve (Receiver operator characteristic) curve, TG-ROC (Two graph - receiver operator characteristic) and logistic regression.
RESULTS: we included 76 patients, of which 51 completed the study. They formed two groups, those who have had good adequacy for hemodialysis (45) and those who had not (6). The average flow volume (FV) and the average draining vein diameter (DVD) of each group were, respectively: 940mL/min (95% CI: 829-1052) and 325mL/min (95% CI: 140-510); and 0.48cm (95% CI: 0.45-0.52) and 0.33cm (95% CI: 0.27-0.40). The area under the ROC curve of FV and DVD were 0.926 and 0.766, respectively.
CONCLUSION: the accuracy of the measured volume flow measured at the draining vein to evaluate maturation of hemodialysis arteriovenous fistula was 85%.

**研究目的**：明确多普勒超声（Doppler ultrasonography, USD）在评估血液透析动静脉瘘（hemodialysis arteriovenous fistula, AVF）成熟度中的准确性。
**研究方法**：纳入既往无动静脉瘘病史的患者，所有受试者均接受两次多普勒超声检查。在启动血液透析后，对患者进行通路使用首月的随访，并验证其是否适配血液透析治疗。统计学分析环节，我们计算了特异性、灵敏度、诊断准确率、受试者工作特征（Receiver operator characteristic, ROC）曲线、双图受试者工作特征（Two graph - receiver operator characteristic, TG-ROC）以及逻辑回归指标。
**研究结果**：本研究共纳入76例患者，其中51例完成全部研究流程。根据透析适配情况分为两组：透析适配良好组（45例）与透析适配不良组（6例）。两组的平均血流量（flow volume, FV）与平均引流静脉直径（draining vein diameter, DVD）分别为：适配良好组940mL/min（95%置信区间：829~1052）、325mL/min（95%置信区间：140~510）；适配不良组0.48cm（95%置信区间：0.45~0.52）、0.33cm（95%置信区间：0.27~0.40）。血流量与引流静脉直径的受试者工作特征曲线下面积分别为0.926与0.766。
**研究结论**：通过检测引流静脉血流量以评估血液透析动静脉瘘成熟度的诊断准确率为85%。