[Short-term single-needle hemodialysis on native fistulae: a general review]

In the 1980s, Belgian researchers showed that dialysis with a specific double-lumen cannula and a twin pump-head single-needle system was at least as efficient as conventional double-needle dialysis, based on Kt/V, the hematocrit, nerve conduction and survival. For more than 15 years, single-needle hemodialysis has been used worldwide for specific situations, such as temporary and reversible problems of vascular access or, more recently, at the beginning of hemodialysis with the twin aims of allowing native fistulae to mature and of reducing cannulation complications. Careful monitoring of the dialysis dose is mandatory when single-needle dialysis is used for more than a week, given the risk of under-dialysis (especially by ionic dialysance and dialysis monitor-recorded Kt/V) and the use of ultrapure dialysate, because of the high frequency of backfiltration. The efficiency of single-needle hemodialysis can be improved by increasing the effective blood flow rate to 250 ml/min, using a short 15-gauge stainless-steel needle, and employing a larger dialysis membrane. Detection of abnormal coagulation in hollow fibers necessitates an increase in anticoagulation or the use of a citrate dialysate or dialysers with anticoagulation properties such as filters coated with heparin or vitamin E. Biological hemolysis related to shear stresses between red cells and the needle should be monitored by measuring plasma haptoglobin and lactic deshydrogenase before and after the dialysis session.