Is ionic dialysance useful for early detection of vascular access dysfunction? Six illustrative cases

Continuous ionic dialysance monitoring is a useful clinical tool to determine the dialysis dose in real time in each hemodialysis session. We followed up 49 patients for 16 months. Six patients with a Kt reduction of ≥20% in >3 consecutive hemodialysis sessions were identified. Fistulography demonstrated significant stenosis in all 6 patients. Angioplasty was performed in 5 with an excellent angiographic result and optimal Kt levels were restored. Unexplained and persistent Kt reduction in patients with stable chronic kidney disease under hemodialysis could represent, together with an accurate vascular access examination, a practical and additional indirect method for the early detection of vascular access dysfunction.