The journal of vascular access · 2026
Hemodialysis vascular access flow measurements by AFM® and Transonic® devices: A bicentric comparative study.
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Floris Matteo, Tomei Paola, Piras Alessandro, Lemos Cerqueira Tiago, Pani Sara Maria, Priori Dario, Cosaro Alex, Murgia Michela, Marziali Matteo, Piras Doloretta, Lepori Nicola, Angioi Andrea, Atzeni Alice, Caria Stefania, Ferraro Pietro Manuel, Cabiddu Gianfranca, Gambaro Giovanni, Pani Antonello
Аннотация
OBJECTIVE: Clinical monitoring remains central to vascular access care, while surveillance of vascular access blood flow (Qa) provides information for detecting dysfunction. Ultrasound dilution (UD), such as Transonic®, is widely used for Qa measurement but may be limited by workflow, personnel, and time constraints. Alternatively, conductivity-based approaches integrated into dialysis machines enable automated intradialytic estimation of Qa without interrupting treatment. This bicentric study evaluated agreement between an automated ionic dialysance-based method, AFM®, and UD, and assessed its clinical performance across prespecified Qa ranges.
METHODS: We conducted an observational method-comparison study in two Italian hemodialysis centers. Paired Qa measurements were obtained in 64 patients during routine hemodialysis sessions using AFM® and Transonic®. Agreement and association were assessed using Spearman correlation, Passing-Bablok regression, Bland-Altman analysis, Lin's concordance correlation coefficient, and weighted Cohen's kappa. Clinical performance was evaluated across prespecified Qa ranges: ⩽600, >600 to <2000, and ⩾2000 mL/min.
RESULTS: Median Qa was 1145 (IQR, 807-1536) mL/min with AFM and 1436 (IQR, 947-1980) mL/min with UD. The two methods showed strong correlation (ρ = 0.849, p < 0.001) and moderate-to-good concordance (CCC = 0.73). Bland-Altman analysis revealed a systematic underestimation at higher flows, with magnitude-dependent variability. Overall categorical agreement was 84% (weighted κ = 0.72). Performance was highest in the clinically relevant ranges of ⩽600 and >600 to <2000 mL/min, with 100% and 93% sensitivities, and F1-scores of 0.89 and 0.88, respectively. Agreement declined in the high-flow range (⩾2000 mL/min), where sensitivity dropped to 53%.
CONCLUSION: AFM® showed strong correlation and substantial clinical agreement with UD, particularly in the low- and intermediate-flow ranges most relevant to routine vascular access surveillance. Its automated intradialytic implementation supports its use as a practical screening tool for Qa surveillance. However, high-flow measurements should be interpreted cautiously and further evaluated when clinically indicated.
METHODS: We conducted an observational method-comparison study in two Italian hemodialysis centers. Paired Qa measurements were obtained in 64 patients during routine hemodialysis sessions using AFM® and Transonic®. Agreement and association were assessed using Spearman correlation, Passing-Bablok regression, Bland-Altman analysis, Lin's concordance correlation coefficient, and weighted Cohen's kappa. Clinical performance was evaluated across prespecified Qa ranges: ⩽600, >600 to <2000, and ⩾2000 mL/min.
RESULTS: Median Qa was 1145 (IQR, 807-1536) mL/min with AFM and 1436 (IQR, 947-1980) mL/min with UD. The two methods showed strong correlation (ρ = 0.849, p < 0.001) and moderate-to-good concordance (CCC = 0.73). Bland-Altman analysis revealed a systematic underestimation at higher flows, with magnitude-dependent variability. Overall categorical agreement was 84% (weighted κ = 0.72). Performance was highest in the clinically relevant ranges of ⩽600 and >600 to <2000 mL/min, with 100% and 93% sensitivities, and F1-scores of 0.89 and 0.88, respectively. Agreement declined in the high-flow range (⩾2000 mL/min), where sensitivity dropped to 53%.
CONCLUSION: AFM® showed strong correlation and substantial clinical agreement with UD, particularly in the low- and intermediate-flow ranges most relevant to routine vascular access surveillance. Its automated intradialytic implementation supports its use as a practical screening tool for Qa surveillance. However, high-flow measurements should be interpreted cautiously and further evaluated when clinically indicated.