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Validation of a revised slow-stop flow recirculation method

T Kapoian1, C A Steward, R A Sherman

  • 1Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.

Kidney International
|September 18, 1997
PubMed
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A revised slow-stop flow (S/SF) method accurately measures hemodialysis recirculation. This improved urea-based technique reliably detects recirculation, with values over 10% indicating true recirculation.

Area of Science:

  • Nephrology
  • Vascular Access
  • Dialysis Technology

Background:

  • Slow flow/stop flow (S/SF) methods are preferred for measuring hemodialysis recirculation.
  • Potential inaccuracies exist due to BUN (blood urea nitrogen) changes in systemic samples with S/SF.
  • Recirculation is unlikely if access blood flow rate exceeds dialyzer blood flow rate.

Purpose of the Study:

  • To evaluate a modified S/SF technique for measuring recirculation.
  • To compare the modified S/SF method with indicator velocity dilution (IVDM).
  • To assess the reliability of the modified S/SF method in detecting true recirculation.

Main Methods:

  • Studied 50 patients undergoing hemodialysis.
  • Compared a revised S/SF method (systemic sample drawn after reducing pump rate to 120 ml/min for 10 seconds, then stopping) with IVDM.

Related Experiment Videos

  • Analyzed access blood flow rate (BFR) versus dialyzer BFR.

    • Main Results:

    • Seven patients showed recirculation by IVDM; all had S/SF recirculation >10% (min 16.7%) and access BFR < dialyzer BFR.
    • In 43 patients without IVDM recirculation, mean S/SF recirculation was 1.9 +/- 3.2%.
    • Five patients without IVDM recirculation showed S/SF values between 5.9% and 8.3%.

    Conclusions:

    • The modified S/SF urea-based method reliably detects hemodialysis recirculation.
    • Single S/SF values >10% strongly suggest true recirculation.
    • Repeated S/SF values >5% likely indicate true recirculation and marginal access blood flow.