Medida del flujo de la fístula arteriovenosa por método de gradiente de temperatura comparado con la ecografía Doppler. Capacidad de predicción de la presencia de estenosis.

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Bibliographic Details
Title:	Medida del flujo de la fístula arteriovenosa por método de gradiente de temperatura comparado con la ecografía Doppler. Capacidad de predicción de la presencia de estenosis.
Alternate Title:	Measurement of arteriovenous fistula flow using the temperature gradient method compared with Doppler ultrasound: predictive capacity for the presence of stenosis.
Authors:	Rosique, Florentina¹ flori.rosique@gmail.com, Martínez-Alarcón, Laura¹, Ramis, Guillermo², Andúgar, Leonor¹, del Carmen Pérez, María³, Araque, Alicia³, Hadad-Arrascue, Fernando¹, García-Puente, Julio¹, José Carbonell, Daniel¹, Roca-Tey, Ramón⁴, Martínez-Losa, Adoración¹, Cabezuelo, Juan B.¹
Source:	Nefrologia. Jun/Jul2026, Vol. 46 Issue 6, p1-8. 8p.
Subjects:	STENOSIS, DOPPLER ultrasonography, HEMODIALYSIS, THERMAL gradient measurment, BLOOD flow measurement, PREDICTION models, ARTERIOVENOUS fistula
Abstract (English):	Introduction: The most common complication of arteriovenous fistula (AVF) is stenosis, which can result in poorer haemodialysis (HD) outcomes and thrombosis. It is important to identify stenoses at high risk of thrombosis, so elective treatment can be performed to restore their function. Objectives: 1) To assess the degree of agreement between Doppler ultrasound (DU) and the temperature gradient technique (TGT) for blood flow measurement (QA). 2) To evaluate the relative importance of different monitoring and/or surveillance methods for detecting significant stenosis using a predictive model. Methods: A cross-sectional, comparative, observational study was conducted, in which the AVFs of 30 consecutive patients were assessed over a 3-month period, with monthly sampling. First-generation methods were applied, and second-generation methods using TGT and DU were used to measure QA. Results: 80% men and 20% women, mean age 67.03 ± 10.25 years. 100% were hypertensive and 63.33% diabetic. 76.67% had a radiocephalic VAF and 23.33% a humeral VAF. The mean QA by TGT was 980.79 ± 63.86 ml/min and by DUS 1098.43 ml/min. Four significant stenoses were detected in the first sampling, none in the second, and three in the third. In samplings 1 and 3, statistically significant differences were detected in the measurement of QG by TGT and ultrasound. No significant differences were found in any parameter measured by the first-generation method, except for the PV in the first sampling. In the BlandAltman analysis, a 96.7% agreement was observed between the QA measurements by TGT and by DU (p1000 ml/min also showed agreement between the two methods, with a deviation of only 4.34%). When first- and second-generation variables were introduced into the predictive model, four combinations with a significant Wilks’ lambda were identified. The combination including QA determined by ultrasound was the most significant, with an overall correct classification of 80.5% when first-generation methods were included together with ultrasound-measured QA. Conclusion: In our study, the agreement between QA measurement by TGT and Doppler ultrasound is high at all flow levels. Furthermore, the predictive model demonstrates that second-generation methods are superior to first-generation methods for the early detection of clinically significant stenosis. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción: La complicación más frecuente de la fístula arteriovenosa (FAV) es la estenosis, que puede derivar en una peor calidad de las hemodiálisis (HD) y en trombosis. Es importante detectar aquellas estenosis con alto riesgo de trombosis para poder realizar un tratamiento electivo que restaure su funcionamiento. Objetivos: 1) Valorar el grado de concordancia entre la ecografía Doppler (ED) y la técnica de gradiente de temperatura (TGT) para las determinaciones de flujo sanguíneo (QA). 2) Valorar el peso relativo de los diferentes métodos de monitorización y/o vigilancia para detectar estenosis significativa mediante un modelo predictivo. Métodos: Se realizó un estudio observacional, de corte transversal y comparativo, donde se evaluaron las FAV de 30 pacientes consecutivos, durante 3 meses, realizando un muestreo mensual. Se aplicaron métodos de primera generación, y para medir el QA métodos de segunda mediante TGT y ED. Resultados: El 80% eran varones y el 20% mujeres, con una edad media de 67,03 ± 10,25 años. El 100% eran hipertensos y 63,33% diabéticos. El 76,67% tenían una FAV radiocefálica y 23,33% humeral. La media del QA por TGT fue 980,79 ± 63,86 ml/min y por ED 1098,43 ml/min. En el primer muestreo se detectaron 4 estenosis significativas, en el segundo ninguna y en el tercer muestreo 3. En los muestreos 1 y 3 se detectaron diferencias estadísticamente significativas para la medición del QA por TGT y ecografía. No se encontraron diferencias significativas en ningún parámetro realizado por método de primera generación, excepto en la PV en el primer muestreo. En el análisis de Bland-Altman, se objetivó una concordancia entre la medida del QA por TGT y por ED del 96,7% (p<0,0001). El dot plot para la diferencia de cada medida con la media para FAV con QA > 1000 ml/min también mostró concordancia entre ambos métodos, con solo una desviación del 4,34%. Al introducir en el modelo predictivo las variables de primera y segunda generación, se identificaron cuatro combinaciones con lambda de Wilks significativa. La combinación que incluye los Q determinados por ecografía fueron los más significativos, con asignación global correcta del 80,5% cuando incluye métodos de primera generación junto con QA medido por ecografía. Conclusión: En nuestro trabajo la concordancia entre la medición del QA por TGT y ecografía Doppler es elevada en todos los niveles de flujo. Además, el modelo predictivo demuestra que los métodos de segunda generación son superiores a los métodos de primera para detectar estenosis clínicamente significativas precozmente. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Introduction: The most common complication of arteriovenous fistula (AVF) is stenosis, which can result in poorer haemodialysis (HD) outcomes and thrombosis. It is important to identify stenoses at high risk of thrombosis, so elective treatment can be performed to restore their function. Objectives: 1) To assess the degree of agreement between Doppler ultrasound (DU) and the temperature gradient technique (TGT) for blood flow measurement (QA). 2) To evaluate the relative importance of different monitoring and/or surveillance methods for detecting significant stenosis using a predictive model. Methods: A cross-sectional, comparative, observational study was conducted, in which the AVFs of 30 consecutive patients were assessed over a 3-month period, with monthly sampling. First-generation methods were applied, and second-generation methods using TGT and DU were used to measure QA. Results: 80% men and 20% women, mean age 67.03 ± 10.25 years. 100% were hypertensive and 63.33% diabetic. 76.67% had a radiocephalic VAF and 23.33% a humeral VAF. The mean QA by TGT was 980.79 ± 63.86 ml/min and by DUS 1098.43 ml/min. Four significant stenoses were detected in the first sampling, none in the second, and three in the third. In samplings 1 and 3, statistically significant differences were detected in the measurement of QG by TGT and ultrasound. No significant differences were found in any parameter measured by the first-generation method, except for the PV in the first sampling. In the BlandAltman analysis, a 96.7% agreement was observed between the QA measurements by TGT and by DU (p1000 ml/min also showed agreement between the two methods, with a deviation of only 4.34%). When first- and second-generation variables were introduced into the predictive model, four combinations with a significant Wilks’ lambda were identified. The combination including QA determined by ultrasound was the most significant, with an overall correct classification of 80.5% when first-generation methods were included together with ultrasound-measured QA. Conclusion: In our study, the agreement between QA measurement by TGT and Doppler ultrasound is high at all flow levels. Furthermore, the predictive model demonstrates that second-generation methods are superior to first-generation methods for the early detection of clinically significant stenosis. [ABSTRACT FROM AUTHOR]
ISSN:	02116995
DOI:	10.1016/j.nefro.2026.501527