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Blood flow rate and access recirculation in hemodialysis.
I D Daniels1, G M Berlyne, R H Barth
1VA Medical Center, Brooklyn, NY.
The International Journal of Artificial Organs
|August 1, 1992
Summary
Access recirculation increases with blood flow rate (BFR) during hemodialysis, but urea clearance still improves. High recirculation may indicate arterial stenosis, even with low venous pressures.
Area of Science:
- Nephrology
- Vascular Access
Background:
- Access recirculation (recirc) is a complication in hemodialysis that can reduce treatment efficacy.
- Extracorporeal blood flow rate (BFR) is a key factor influencing recirc.
Purpose of the Study:
- To investigate the impact of varying blood flow rates (BFR) on access recirculation (recirc) in hemodialysis patients.
- To determine the relationship between recirc, access stenosis, and urea clearance.
Main Methods:
- Studied 19 hemodialysis patients at BFRs of 200, 400, and 600 ml/min.
- Measured BUN in peripheral, arterial, and venous blood to calculate percent recirc.
- Performed fistulograms and measured venous drip-chamber (VP) and pre-blood-pump (AP) pressures.
Main Results:
- Recirculation increased with BFR from 200 to 400 ml/min, with minimal increase from 400 to 600 ml/min.
- Patients with arterial-side stenoses exhibited higher recirc at all BFRs.
- Urea clearance, corrected for recirc, increased with BFR in both stenotic and non-stenotic patients.
- A recirc threshold of 15% at BFR ≥ 400 ml/min identified stenoses with 100% sensitivity and 71% specificity.
Conclusions:
- Increased BFR raises recirc, but not enough to negate improved urea clearance.
- Significant access stenosis and recirc can occur despite low venous pressures.
- Recirc is linked to arterial-side access stenoses.
- Recirc > 15% at BFR ≥ 400 ml/min suggests access stenosis.