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RESULTSThe QIP group comprised 44 patients (59 ± 17 years), the concurrent control group 48 patients (59 ± 16 years), the historic control group 57 patients (58 ± 15 years). Six-month post-AVF creation, the fraction of non-censored patients with catheter in place was 21% in the QIP cohort, 67% in the concurrent control group, and 68% in the historic control group. In unadjusted and adjusted analysis, catheter residence time post-fistula creation was shorter in QIP patients compared to either control groups (p < 0.001).CONCLUSIONScvO2-based assessment of fistula maturation is associated with shorter catheter residence post-AVF creation.INTRODUCTIONArteriovenous fistula (AVF) maturation assessment is essential to reduce venous catheter residence. We introduced central venous oxygen saturation (ScvO2) and estimated upper body blood flow (eUBBF) to monitor newly created fistula maturation and recorded catheter time in patients with and without ScvO2-based fistula maturation.METHODSFrom 2017 to 2019, we conducted a multicenter quality improvement project (QIP) in hemodialysis patients with the explicit goal to shorten catheter residence time post-AVF creation through ScvO2-based maturation monitoring. In patients with a catheter as vascular access, we tracked ScvO2 and eUBBF pre- and post-AVF creation. The primary outcome was catheter residence time post-AVF creation. We compared catheter residence time post-AVF creation between QIP patients and controls. One control group comprised concurrent patients; a second control group comprised historic controls (2014-2016). We conducted Kaplan-Meier analysis and constructed a Cox proportional hazards model with variables adjustment to assess time-to-catheter removal.

DISCUSSIONConcurrent combined monitoring of intradialytic ScvO2 and RBV change may provide additional insights into a patient's circulatory status. Patients with low ScvO2 and small changes in RBV may represent a specifically vulnerable group of patients at particularly high risk for adverse outcomes, possibly related to poor cardiac reserve and fluid overload.INTRODUCTIONIn maintenance hemodialysis (HD) patients, low central venous oxygen saturation (ScvO2 ) and small decline in relative blood volume (RBV) have been associated with adverse outcomes. Here we explore the joint association between ScvO2 and RBV change in relation to all-cause mortality.FINDINGSBaseline comprised 5231 dialysis sessions in 216 patients. The median RBV change was -5.5% and median ScvO2 was 58.8%. During follow-up, 44 patients (20.4%) died. In the adjusted model, all-cause mortality was highest in patients with ScvO2 below median and RBV change above median (HR 6.32; 95% confidence interval [CI] 1.37-29.06), followed by patients with ScvO2 below median and RBV change below median (HR 5.04; 95% CI 1.14-22.35), and ScvO2 above median and RBV change above median (HR 4.52; 95% CI 0.95-21.36).METHODSWe conducted a retrospective study in maintenance HD patients with central venous catheters as vascular access. During a 6-month baseline period, Crit-Line (Fresenius Medical Care, Waltham, MA) was used to measure continuously intradialytic ScvO2 and hematocrit-based RBV. We defined four groups per median change of RBV and median ScvO2 . Patients with ScvO2 above median and RBV change below median were defined as reference. Follow-up period was 3 years. We constructed Cox proportional hazards model with adjustment for age, diabetes, and dialysis vintage to assess the association between ScvO2 and RBV and all-cause mortality during follow-up.