Hemodialysis Vascular Sound Index as a Diagnostic Tool for Vascular Access Stenosis: A Prospective Case-Control Study

Background and objectives: Vascular access (VA) monitoring is critical for hemodialysis patients. While Doppler ultrasound (US) provides high diagnostic accuracy for VA stenosis, its reliance on specialized training limits its routine use. The Hemodialysis Vascular Sound Index (HVSI), derived from vascular murmur analysis, may provide a simple, objective alternative. This study evaluates the diagnostic performance of the HVSI in detecting VA stenosis and reduced flow volume (FV). Methods: This prospective case-control study included 202 hemodialysis patients (101 with stenosis, 101 control). HVSI was measured with an electronic stethoscope placed over the VA site. FV and resistance index (RI) were assessed by Doppler US. Stenosis was diagnosed by clinical criteria and confirmed by Doppler US. Diagnostic accuracy was determined from receiver operating characteristics, including sensitivity, specificity, and area under the curve (AUC). Results: HVSI showed significant correlations with FV (R² = 0.58) and RI (R² = 0.32). For FV thresholds ≤500, ≤400, and ≤350 mL/min, HVSI showed sensitivities of 86.3-94.4%, specificities of 78.7-82.9%, and AUCs of 0.90-0.94. Diagnostic accuracy was higher in non-bifurcated vessels. Discussion and Conclusion: HVSI has significant potential to improve routine surveillance of VA. Further research is needed to validate its use in different patient populations.