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OM019 – Table 1. RR and VA type Cox Regression Model Graft RR Graft Range p Permanent Catheter RR Permanent Catheter Range p AVF Model 1: No adjustment 1.106 1.02-1.20 0.016 1.86 1.69-2.10 p<0.0001 REF Model 2: Case mix adjusted NS NS NS 1.94 1.74-2.16 p<0.0001 REF Model 3: Model 2 + comorbidities NS NS NS 1.93 1.73-2.15 p<0.0001 REF Model 4: Model 3 + baseline labs NS NS NS 1.59 1.25-2.03 p<0.0001 REF coronary heart disease, heart failure, stroke, chronic obstructive pulmonary disease, neoplasm) and Model 4: Model 3 + weight + six main baseline laboratory values (hemoglobin, calcium, phosphorous, Kt/Ve, C reactive protein, albumin). In every model AVF was used as reference for RR. Results: According to selection criteria, 13,014 incident patients were included and 43,438 VA were created on these patients. Mean age was 58.6±16.4 years, 52.2% male, 30.1% diabetics. Mean survival time according to VA type was 5.75 years for AVF, 5.72 years for grafts and 4.38 years for permanent catheter (PC) (p<0.0001). RR for mortality and VA type is shown in table 1. Conclusions: Permanent catheter showed an independent effect on patient survival that remains after adjusting for case mix, comorbidities, weight and main baseline laboratory values. The impact of graft in survival fades out after adjustment in our population. Given that this is an observational study, prospective, controlled clinical trials are needed to support our findings. OM020 BEDSIDE STENOSIS SURVEILLANCE PROGRAM IN ARTERIOVENOUS FISTULA (AVF) MAY BE GUIDED BY THE ANASTOMOTIC SITE Valeria Bedogna 1, Nicola Tessitore 1, Edoardo Melilli 1 , Albino Poli 2, Giovanni Lipari 3, Elda Baggio 3, William Mantovani 2, Giancarlo Mansueto 4, Antonio Lupo 1. 1Servizio Emodialisi Policlinico, Divisione di Nefrologia, Verona, Italy; 2Dipartimento di Medicina e Salute Pubblica, Verona, Italy; 3Dipartimento di Scienze Chirurghiche, Verona, Italy; 4Istituto di Radiologia, Verona, Italy Introduction and Aims: Due to the different stenosis location and access blood flow (Qa) levels, it has been postulated that the diagnostic criteria for stenosis in AVF may vary according to the anastomotic site. Methods: To test this hypothesis, we evaluated the diagnostic accuracy of physical exam (PE), Qa and access recirculation (by ultrasound dilution technique), Qb/NAP (the ratio of dialysis blood pump flow to negative arterial pre-pump pressure), and derived static venous pressure (VAPR, according to Frinak et al.) in detecting angiographically-proven stenosis in 100 hemodialysis patients (pts) (70 males, 30 females, aged 67±16 y) with mature AVF. Results: The arteriovenous anastomosis was located in the lower third of the forearm (dAVF) in 36 pts, and more proximally in the remaining 64 pts (pAVF), either in the mid-third of the forearm (n=31) or in the elbow region (n=33). Fistulography identified 15 stenoses in dAVF, all located upstream to the venous needle (inflow stenosis, STin), and 38 in pAVF, 25 located upstream (STin) and 13 downstream to the venous needle (outflow stenosis, STout). The distribution of STin was independent of the anastomotic site (39% in pAVF vs 42% in dAVF, p=ns), while STout was only documented in pAVF (20% vs none in dAVF, p=0.011). Qa<650 ml/min and a positive PE were the only significant predictors of STin in dAVF (accuracy (AC) 82% [95% CI 60-92], sensitivity (SE) 79% [49-95], specificity (SP) 85% [62-97] for Qa and AC 76% [59-89], SE 64% [35-87] and SP 85% [62-97] for PE). The combination of the two tests using PE as a triage followed by Qa measurement in the event of a negative PE slightly improved AC up to 85% [69-95], due to a substantial increase in SE to 93% [66-99] without unduly reducing SP (80% [56-94]). In pAVF, Qa<900 ml/min and a positive PE were significant predictors of STin (AC 77% [62-84], SE 86% [65-97], SP 68% [46-85] and AC 68% [38-90], SE 64% [35-87%], SP 72% [46-88], respectively). The combination of the two slightly improved AC (82% [67-91]), due to a substantial increase in SE (95% [77-99]) and no change in SP (71% [47-85]). STout could only be predicted by VAPR>0.5 (AC 83% [66-93], SE 93% [61-99], SP 78% [56-92]) and a positive PE (AC 79% [63-90], SE 69% [38-91], SP 84% [64-95]. The combination of the two slightly improved AC (87% [72-95]), with no change in the best SE by VAPR (94% [64-99]), nor in the best SP by PE (84% [64-95]). Conclusions: Our study shows that an effective stenosis surveillance program (with excellent accuracy, high sensitivity and acceptable specificity) can be achieved at the bedside in AVF. It also suggests that the choice of the screening procedures should be tailored to the location of the arteriovenous anastomosis, PE and Qa measurement being the optimal tools in distal forearm AVF, while derived static venous pressure should be added to PE and Qa in more proximally located accesses. OM021 FUNCTIONAL STUDY OF VASCULAR ACCESS (VA) IN PATIENTS WITH DIABETIC NEPHROPATHY (DN) R. Roca-Tey, R. Samon, O. Ibrik, I. Giménez, C. Cabrera, R. Martínez-Cercós, J. Viladoms. Departments of Nephrology and Vascular Surgery, Fundació Privada Hospital de Mollet, Barcelona, Spain Introduction and Aims: The best method of VA surveillance in endstage renal disease (ESRD) patients (pts) is periodic blood flow (QA) measurement. The aim of this prospective study is to report a five-year experience of VA stenosis surveillance by QA measurements in pts with DN. Methods: We monitored QA of 145 VA in 131 ESRD pts over 5 yr period. Of them, we analyzed 26 VA in 25 pts with DN (prevalence 17.9%). QA was measured during the first hour of the HD session at least every 4 months by Delta-H method. Baseline QA was calculated from two consecutive HD sessions (the values were averaged). All VA with absolute QA<700 ml/min or ∇A >20% from baseline over time met the positive evaluation (PE) criteria and were referred for angiography plus subsequent elective intervention if VA stenosis ≥50%. Mean arterial pressure (MAP) was measured simultaneous with QA. Results: Variable VA of pts with DN VA of pts without DN p VA/pts 26/25 119/106 Gender (%) Male 61.5; Female 38.5 Male 60.5; Female 39.5 1.00 Mean age (years) 65.4±10.8 61.9±13.9 0.33 Time on HD (months) 23.9±28.3 32.9±48.9 0.85 At least one comorbidity other than diabetes (%)* 69.2 32.8 0.001 Baseline MAP (mmHg) 97.0±10.9 94.7±13.4 0.43 Overall MAP (mmHg) 96.8±10.0 93.6±12.9 0.18 Type of VA (%) AVF 84.6, AVG 15.4 AVF 84.0, AVG 16.0 1.00 VA duration (months) 14.6±16.7 30.6±59.2 0.73 Ratio number VA/patient 1.85±1.48 1.99±1.59 0.52 Baseline QA (ml/min) 887.4±407.1 1142.9±429.3 0.006 Overall QA (ml/min) 921.2±405.3 1220.3±471.4 0.002 VA with PE (%) 53.8 27.7 0.010 VA with stenosis ≥ 50% (%) 50 21.8 0.003 Elective VA intervention (%) 26.9 12.6 0.076 QA after elective intervention (ml/min) 314.3±91.2 477.6±349.2 0.28 VA thrombosis (%) 7.7 17.6 0.37 Thrombosis rate (episodes/VA/year) 0.047 0.128 0.063 Primary patency (months)** 36.3 (24.7-48.0) 36.9 (31.8-42.0) 0.93 Secondary patency (months)** 47.9 (38.8-57.1) 43.5 (38.2-48.7) 0.35 *Ischaemic cardiopathy or cerebrovascular disease or peripheral arteriopathy. **Results are expressed as mean and 95% confidence intervals. Conclusions: 1) The functional VA profile is worse in pts with DN. 2) The prevalence of significant VA stenosis is higher in pts with DN. 3) The surveillance program applied can explain the similar VA thrombosis and patency rates obtained during the study period. Monday, June 28, 2010 Epidemiology and outcome research 2 iii559 OM022 COST ANALYSIS OF ONGOING CARE OF FISTULAE THROMBOSIS IN DIALYSIS PATIENTS: THE IMPACT OF ANGIOPLASTY PERFORMED BY

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