Sonographic reproducibility of a novel approach in the assessment of centralised access in end-stage renal disease.

A reliable and accurate non-invasive test is needed to help determine grafts and/or fistulae in end-stage renal disease (ESRD) patients. Sonographic scanning to assess the state of the fistula and AV shunt seems underused. To find out what role B-mode and Doppler play in the assessment of fistula and shunt, we scanned nine patients with a fistula as central access and nine patients with a graft several times over a period of a month. Diameters were measured before and after the AV shunt and Doppler measurements were made pre, inter and post shunt. We established that B-mode measurements are reliable in predicting the future and integrity of both fistulae and grafts. Doppler measurements were less consistent and therefore less reliable. The average initial measurement showed a screen of 5.766 mm and a second measurement of 5.890 mm; The coefficient of variation (CV)/reproducibility was 1.58% for first measurement. The average first and second measurements post graft were 6.317 mm and 6.365 mm, respectively. The CV/reproducibility was 0.48%. First and second peak flow measurements averaged 149 m/s and 112 m/s, respectively, resulting in a CV of 14.0%. We conclude that morphological changes may be more reliable than Doppler values, indicating a potentially greater use for B-mode ultrasound in predicting an open shunt and/or fistula.

Regression growth evaluation statin study (REGRESS): study design and baseline characteristics in 600 patients. The REGRESS Research Group.

OBJECTIVE: To assess the effects of lipid lowering, using a hydroxymethyl glutaryl coenzyme A reductase inhibitor (pravastatin) in symptomatic men with coronary artery disease. To assess follow-up intervention modes and baseline cardiovascular risk factors in men after routine diagnostic coronary arteriography which showed a significant stenosis (at least 50%) in a major segment. DESIGN: Baseline characteristics are stated in a multicentre, prospective, double-blind, randomized, placebo-controlled trial entitled 'regression growth evaluation statin study' (REGRESS). SETTING: Seven university hospitals and four referral hospitals in The Netherlands. PATIENTS: The baseline characteristics are given for the initial 600 patients who entered the REGRESS trial. All patients were 'normocholesterolemic' and suffered from symptomatic coronary artery disease. INTERVENTION: Initial follow-up treatment was analyzed after coronary arteriography, in accordance with standardized clinical practice (angioplasty, bypass grafting or medical management only). MAIN RESULTS: In contrast to routine procedures, 44% of the patient population was found in the medical management only stratum, whereas 32% was found in the coronary bypass graft and 24% in the percutaneous transluminal coronary angioplasty stratum. No major coronary cardiovascular risk factor could explain the decision to perform a certain follow-up intervention. Overall patients showed a low serum high density lipoprotein (HDL) cholesterol level. A higher New York Heart Association classification for anginal complaints tended to favour a more aggressive follow-up approach. CONCLUSIONS: The total REGRESS population showed relatively low HDL cholesterol blood levels compared with the general Dutch population. The rationale to perform a specific follow-up intervention by the treating cardiologist is unclear. Severity of anginal complaints may lead to a more active intervention procedure.