Observational studyScience progress
Documented arteriovenous fistula thrill category and Doppler hemodynamics in mature radiocephalic fistulas: A single-center retrospective study.
Observational study in Science progress. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
ObjectiveTo evaluate the cross-sectional association between routinely documented arteriovenous fistula thrill categories and Doppler hemodynamic parameters in mature radiocephalic fistulas.MethodsThis single-center retrospective observational study included 474 patients receiving maintenance hemodialysis with mature native radiocephalic fistulas who underwent color Doppler ultrasound between January 2021 and March 2025. Each patient contributed one eligible examination with same-visit thrill documentation classified as strong, weak, or absent before Doppler interpretation. Hemodynamic parameters, lesion-related records, exploratory receiver operating characteristic analyses, multivariable associations with abnormal thrill, and Doppler reproducibility were evaluated.ResultsOf 474 patients, 367 had strong thrill, 67 had weak thrill, and 40 had absent thrill. Median brachial artery blood flow decreased across the strong, weak, and absent groups from 783 to 206 and 86 mL/min, respectively, whereas median brachial artery resistance index increased from 0.53 to 0.78 and 1.00 (overall P < 0.001 for both). Stenosis-related records were most frequent in the weak-thrill group, whereas thrombosis-related records were concentrated in the absent-thrill group. For exploratory discrimination of abnormal versus strong thrill, blood flow had an AUC of 0.987 at a cohort-specific cutoff of 376 mL/min (sensitivity 98.1%, specificity 92.4%), and resistance index had an AUC of 0.969 at a cutoff of 0.69 (sensitivity 87.9%, specificity 95.9%). In the principal adjusted model, lower blood flow and higher resistance index remained independently associated with abnormal thrill (adjusted OR 0.25 per 100 mL/min and 2.92 per 0.1 unit, respectively; both P < 0.001). Measurement reproducibility was high.ConclusionsRoutinely documented thrill category was associated with Doppler hemodynamics in mature radiocephalic fistulas. The exploratory cutoffs describe separation between documentation groups and should not be interpreted as validated diagnostic thresholds or evidence of a thrill-based triage strategy.
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