{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:50:40Z","timestamp":1791568240750,"version":"4.3.4"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      Clinical monitoring remains central to vascular access care, while surveillance of vascular access blood flow (Qa) provides information for detecting dysfunction. Ultrasound dilution (UD), such as Transonic\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , is widely used for Qa measurement but may be limited by workflow, personnel, and time constraints. Alternatively, conductivity-based approaches integrated into dialysis machines enable automated intradialytic estimation of Qa without interrupting treatment. This bicentric study evaluated agreement between an automated ionic dialysance\u2013based method, AFM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , and UD, and assessed its clinical performance across prespecified Qa ranges.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We conducted an observational method-comparison study in two Italian hemodialysis centers. Paired Qa measurements were obtained in 64 patients during routine hemodialysis sessions using AFM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      and Transonic\n                      <jats:sup>\u00ae<\/jats:sup>\n                      . Agreement and association were assessed using Spearman correlation, Passing\u2013Bablok regression, Bland\u2013Altman analysis, Lin\u2019s concordance correlation coefficient, and weighted Cohen\u2019s kappa. Clinical performance was evaluated across prespecified Qa ranges: \u2a7d600, &gt;600 to &lt;2000, and \u2a7e2000\u2009mL\/min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Median Qa was 1145 (IQR, 807-1536) mL\/min with AFM and 1436 (IQR, 947-1980) mL\/min with UD. The two methods showed strong correlation (\u03c1\u2009=\u20090.849,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and moderate-to-good concordance (CCC\u2009=\u20090.73). Bland\u2013Altman analysis revealed a systematic underestimation at higher flows, with magnitude-dependent variability. Overall categorical agreement was 84% (weighted \u03ba\u2009=\u20090.72). Performance was highest in the clinically relevant ranges of \u2a7d600 and &gt;600 to &lt;2000\u2009mL\/min, with 100% and 93% sensitivities, and F1-scores of 0.89 and 0.88, respectively. Agreement declined in the high-flow range (\u2a7e2000\u2009mL\/min), where sensitivity dropped to 53%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      AFM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      showed strong correlation and substantial clinical agreement with UD, particularly in the low- and intermediate-flow ranges most relevant to routine vascular access surveillance. Its automated intradialytic implementation supports its use as a practical screening tool for Qa surveillance. However, high-flow measurements should be interpreted cautiously and further evaluated when clinically indicated.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298261489366","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:09:03Z","timestamp":1791432543000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodialysis vascular access flow measurements by AFM\n                    <sup>\u00ae<\/sup>\n                    and Transonic\n                    <sup>\u00ae<\/sup>\n                    devices: A bicentric comparative study"],"prefix":"10.1177","author":[{"given":"Matteo","family":"Floris","sequence":"first","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. Brotzu Hospital, Cagliari, Italy"},{"name":"Medical Science and Public Health Department, University of Cagliari, Monserrato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Tomei","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Piras","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. Brotzu Hospital, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8651-4728","authenticated-orcid":false,"given":"Tiago","family":"Lemos Cerqueira","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. Brotzu Hospital, Cagliari, Italy"},{"name":"Nephrology and Transplant Department, Hospital Felicio Rocho, Belo Horizonte, Brazil"},{"name":"Department of Clinical Research, Dresden International University, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5594-8497","authenticated-orcid":false,"given":"Sara Maria","family":"Pani","sequence":"additional","affiliation":[{"name":"Medical Science and Public Health Department, University of Cagliari, Monserrato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Priori","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Cosaro","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8713-3811","authenticated-orcid":false,"given":"Michela","family":"Murgia","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. 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Brotzu Hospital, Cagliari, Italy"},{"name":"Medical Science and Public Health Department, University of Cagliari, Monserrato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8311-5409","authenticated-orcid":false,"given":"Andrea","family":"Angioi","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. Brotzu Hospital, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Atzeni","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. Brotzu Hospital, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Caria","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, Universit\u00e0 degli Studi di Cagliari, G. 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