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It previews an approach using digital auscultation with acoustic frequency analysis and an HLPR-based index to distinguish functioning from nonfunctioning AVFs.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/listening-to-the-lifeline-harnessing-sound-to-monitor-dialysis-vascular-access/452668/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/listening-to-the-lifeline-harnessing-sound-to-monitor-dialysis-vascular-access/452668.png","ImageObject",300,407,{"name":42,"@type":43},"hdkawk","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is vascular access monitoring critical in hemodialysis?","Question",{"text":63,"@type":64},"Vascular access determines both effective dialysis treatment and long-term outcomes. Dysfunction—especially stenosis—can cause complications that may ultimately lead to loss of the access site.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What makes stenosis particularly important in dialysis access dysfunction?",{"text":68,"@type":64},"Stenosis is the most prevalent and clinically significant etiology. If unrecognized, it can lead to bleeding, infiltration, inadequate dialysis clearance, hyperkalemia, uremic symptoms, thrombosis, and access loss.",{"name":70,"@type":61,"acceptedAnswer":71},"How does the featured study use sound to assess AVF function?",{"text":72,"@type":64},"The study records fistula sounds with an electronic stethoscope and analyzes spectral content across defined low and high frequency bands. It computes a high-low peak ratio (HLPR) and its natural logarithm to generate an index that distinguishes functioning accesses from those with complications or significant dysfunction.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},452668,1791032999,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":55,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":55,"preview_page_count":4},3985747859855,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Editorial  \nListening to the Lifeline  \nHarnessing Sound to Monitor Dialysis Vascular Access  \nAdina S. Voiculescu  and Dirk M. Hentschel   \nKidney360 6: 1647–1648, 2025. doi: [https://doi.org/10.34067/KID.0000000993](https://doi.org/10.34067/KID.0000000993)  \nVascular access represents both the lifeline and the Achilles' heel of hemodialysis. Although arteriovenous fistulas (AVFs) and grafts are preferred over central venous catheters, creation of functioning accesses and maintaining patency remains challenging for patients with ESKD. A recent analysis demonstrated a primary patency of only 30% and an average of 2.6 procedures needed per patient-year to maintain patency.1  \nAmong the various etiologies of access dysfunction, stenosis is the most prevalent and clinically significant as it remains one of the major causes for complications. If left unrecognized or untreated, stenosis can result in bleeding, infiltrations, inadequate dialysis clearance, hyperkalemia, uremic symptoms, thrombosis, and, ultimately, loss of the access site.  \nPhysical examination of AVFs is a low-cost and effective method for detecting dysfunction by expert examiners.2 More advanced diagnostic modalities, such as ultrasound flow measurements, are often limited by resource availability and variability in both implementation and interpretation.3  \nEndovascular and surgical interventions play an essential role in maintaining access patency; however, timely recognition and referral for evaluation are critical for effective management. Ideally, stenoses should be identified before thrombosis occurs, as thrombosed accesses are not only more challenging to treat but also associated with increased procedural complexity and permanent vascular damage. Whereas balloon angioplasty or stent placement typically require minutes per procedure, thrombectomy procedures may take 1–3 hours, depending on thrombus burden.4 Moreover, while technical success rates for angioplasty and stenting approach 98%, those for thrombectomy range from 70% to 95%,5 which means that up to one of four accesses undergoing thrombectomy is lost.  \nA central issue in the current paradigm is the fragmentation of responsibility for access monitoring. In routine clinical practice, cannulation is performed by dialysis technicians, with oversight from nurses who are concurrently tasked with medication administration and managing patient flow. The recommended pretreatment physical examination consisting of inspection, auscultation, palpation, and the arm elevation test—the “1-minute check”–is advised for every session,5 yet adherence and accurate interpretation vary significantly in practice.6,7  \nNephrologists, who might otherwise play a critical role in access assessment, often lack training in comprehensive vascular access examination. Furthermore, given the timing of dialysis rounds, when patients are typically already cannulated, opportunities for detailed evaluation are limited. Although there is increasing recognition of the need for enhanced dialysis access training among nephrologists,8 ongoing efforts by professional societies such as the American Society for Diagnostic and Interventional Nephrology, American Society of Nephrology, Vascular Access Society of the Americas, and National Kidney Foundation will require time to implement and standardize.  \nConsequently, the burden of access dysfunction recognition currently falls primarily on dialysis unit staff. Given the critical nature of this issue, there is a pressing need for the development of a standardized, simple, and user-friendly tool that can facilitate early detection of access dysfunction with minimal training. Such a tool would be particularly valuable in the context of the growing number of patients choosing home hemodialysis, where patient-performed monitoring may become a cornerstone of care.  \nIn this issue of Kidney360, Poloni et al.9 present an innovative and practical alternative: the use of digital auscultation combined with a","cbCaioL9Zyk1oBop","https://ap.wps.com/l/cbCaioL9Zyk1oBop","pdf",171164,"English","# Editorial\n## Vascular access challenges in hemodialysis\n## Stenosis as a major cause of dysfunction\n## Limits of physical exam and advanced diagnostics\n## Need for standardized early detection tools\n## Acoustic auscultation and frequency analysis approach","[{\"question\":\"Why is vascular access monitoring critical in hemodialysis?\",\"answer\":\"Vascular access determines both effective dialysis treatment and long-term outcomes. Dysfunction—especially stenosis—can cause complications that may ultimately lead to loss of the access site.\"},{\"question\":\"What makes stenosis particularly important in dialysis access dysfunction?\",\"answer\":\"Stenosis is the most prevalent and clinically significant etiology. If unrecognized, it can lead to bleeding, infiltration, inadequate dialysis clearance, hyperkalemia, uremic symptoms, thrombosis, and access loss.\"},{\"question\":\"How does the featured study use sound to assess AVF function?\",\"answer\":\"The study records fistula sounds with an electronic stethoscope and analyzes spectral content across defined low and high frequency bands. It computes a high-low peak ratio (HLPR) and its natural logarithm to generate an index that distinguishes functioning accesses from those with complications or significant dysfunction.\"}]","Listening to the Lifeline - Harnessing Sound to Monitor Dialysis Vascular Access | PDF",1790737549]