Ichiba Shingo    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Evaluating the need for and effect of percutaneous transluminal angioplasty on arteriovenous fistulas by using total recirculation rate per dialysis session ("clearance gap").
Journal	Formal name：Acta medica Okayama Abbreviation：Acta Med Okayama ISSN code：(0386-300X)0386-300X(Linking)
Domestic / Foregin	Domestic
Volume, Issue, Page	66(6),pp.443-7
Author and coauthor	Ugawa Toyomu, Sakurama Kazufumi, Yorifuji Takashi, Takaoka Munenori, Fujiwara Yasuhiro, Kabashima Narutoshi, Azuma Daisuke, Hirayama Takahiro, Tsukahara Kohei, Morisada Sunao, Iida Atsuyoshi, Tada Keitaro, Shiba Naoki, Sato Nobuo, Ichiba Shingo, Kino Koichi, Fukushima Masaki, Ujike Yoshihito
Publication date	2012
Summary	The functioning of an arteriovenous fistula (AVF) used for vascular access during hemodialysis has been assessed mainly by dilution methods. Although these techniques indicate the immediate recirculation rate, the results obtained may not correlate with Kt/V. In contrast, the clearance gap (CL-Gap) method provides the total recirculation rate per dialysis session and correlates well with Kt/V. We assessed the correlation between Kt/V and CL-Gap as well as the change in radial artery (RA) blood flow speed in the fistula before percutaneous transluminal angioplasty (PTA) in 45 patients undergoing continuous hemodialysis. The dialysis dose during the determination of CL-Gap was 1.2 to 1.4 Kt/V. Patients with a 10% elevation or more than a 10% relative increase in CL-Gap underwent PTA (n = 45), and the values obtained for Kt/V and CL-Gap before PTA were compared with those obtained immediately afterward. The mean RA blood flow speed improved significantly (from 52.9 to 97.5cm/sec) after PTA, as did Kt/V (1.07 to 1.30) and CL-Gap (14.1% to -0.2%). A significant correlation between these differences was apparent (r = -0.436 and p = 0.003). These findings suggest that calculating CL-Gap may be useful for determining when PTA is required and for assessing the effectiveness of PTA, toward obtaining better dialysis.
PMID	23254578