Abstract
We propose arterial pCO<sub>2</sub> as test to discover vascular access recirculation (VAR) in bicarbonate hemodialysis (HD). We selected 30 HD patients with a ascertained well-functioning arteriovenous fistula (Control). In these patients, we artificially created VAR through the reversion of HD lines (Reversed). Results of the arterial gas analysis were collected at the start of HD (baseline) and after 5 min. At baseline, no differences of pH, pCO<sub>2</sub> and HCO<sub>3</sub> were found between the 2 groups. At 5 min, pCO<sub>2</sub> increased from 38.1 ± 3.3 to 47.2 ± 6.3 mm Hg (p < 0.0001) in Reversed, whereas no increase was found in Control (p = 0.052). Areas under curve of pCO<sub>2</sub>-increase was 0.96 (0.91-1.00) and pCO<sub>2</sub> at 5 min 0.92 (0.85-0.98). pCO<sub>2</sub>-increase >4.5 mm Hg showed sensitivity 86.7% and specificity 100% with positive predictive value (PPV) 100% and negative predictive value (NPV) 89%. A pCO<sub>2</sub> value above 43 mm Hg at 5 min showed sensitivity 80%, specificity 90%, PPV 89%, NPV 82%. pCO<sub>2</sub> increase >4.5 mm Hg and/or pCO<sub>2</sub> at 5 min >43 mm Hg may accurately detect VAR.
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