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Abstract：
BACKGROUND: Thermodilution is a widely used method for measuring vascular access flow (QA). Among the possibilities of thermodilution, the reverse method (RM) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique.
METHODS: Transversal study of 117 arteriovenous fistulas. Two QA measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen\'s Kappa index were used.
RESULTS: Very good concordance between MR and RM was evidenced for QA below 700ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (-14,12) (P=.287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa=0.834). The time spent using the RM was significantly shorter (P=.000) without evidence of variations in the Kt of the measurement sessions (P=.201).
CONCLUSIONS: The thermodilution RM is valid to determine the flow of the vascular access, especially in QA lower than 700ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good.
METHODS: Transversal study of 117 arteriovenous fistulas. Two QA measurements were taken with the method described by the manufacturer (MR) and another with RM. RM is based on the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen\'s Kappa index were used.
RESULTS: Very good concordance between MR and RM was evidenced for QA below 700ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and RM (inter-method variability), which was 2% (-14,12) (P=.287). The degree of agreement between the 2 to identify arteriovenous fistulas susceptible to intervention was very good (Kappa=0.834). The time spent using the RM was significantly shorter (P=.000) without evidence of variations in the Kt of the measurement sessions (P=.201).
CONCLUSIONS: The thermodilution RM is valid to determine the flow of the vascular access, especially in QA lower than 700ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and RM is similar to that of MR. The concordance between methods in identifying potentially pathological arteriovenous fistulas is very good.
摘要：
背景：热稀释是一种广泛使用的用于测量血管通路流量（QA）的方法。在热稀释的可能性中，反向方法(RM)在执行时间上是有益的，不影响透析疗效（Kt）。然而,这不是一项经过充分研究的技术。
方法：117例动静脉瘘的横向研究。采用制造商(MR)描述的方法进行两次QA测量,另一次采用RM。RM基于在会话开始时获得的反向再循环注册表和在线路处于正常位置的情况下的单个后续再循环测量。在一致性分析中，使用了Bland-Altman方法和Cohen的Kappa指数。
结果：对于低于700ml/min的QA，MR和RM之间的一致性非常好，但随着流量的增加，情况会恶化。MR测量之间的中值变异性(方法内变异性)为3.4%(-17.13)。此值与MR和RM之间产生的中值变异性(方法间变异性)没有差异，这是2%（-14,12）（P=.287）。2．鉴别动静脉瘘易感介入的一致性程度很好（Kappa=0.834）。使用RM所花费的时间明显较短（P=.000），没有测量会话的Kt变化的证据（P=.201）。
结论：热稀释RM可有效确定血管通路的流量，特别是在QA低于700ml/min时，节省大量时间,简化的程序和不改变透析效率。MR和RM测量之间的可变性与MR相似。识别潜在病理性动静脉瘘的方法之间的一致性非常好。
方法：117例动静脉瘘的横向研究。采用制造商(MR)描述的方法进行两次QA测量,另一次采用RM。RM基于在会话开始时获得的反向再循环注册表和在线路处于正常位置的情况下的单个后续再循环测量。在一致性分析中，使用了Bland-Altman方法和Cohen的Kappa指数。
结果：对于低于700ml/min的QA，MR和RM之间的一致性非常好，但随着流量的增加，情况会恶化。MR测量之间的中值变异性(方法内变异性)为3.4%(-17.13)。此值与MR和RM之间产生的中值变异性(方法间变异性)没有差异，这是2%（-14,12）（P=.287）。2．鉴别动静脉瘘易感介入的一致性程度很好（Kappa=0.834）。使用RM所花费的时间明显较短（P=.000），没有测量会话的Kt变化的证据（P=.201）。
结论：热稀释RM可有效确定血管通路的流量，特别是在QA低于700ml/min时，节省大量时间,简化的程序和不改变透析效率。MR和RM测量之间的可变性与MR相似。识别潜在病理性动静脉瘘的方法之间的一致性非常好。
