Prevalence of Access Recirculation in Prevalent Arterio-Venous (A-V) Fistula Hemodialysis Patients and Its Effect on Hemodialysis Adequacy

Abstract

Background: Assessment of access recirculation (AR) is crucial to dialysis efficiency and there is thus a need for a method yielding a highly accurate, fast, easy and economical measurement that can be applied in any dialysis clinic. Non-urea based dilutional methods are more accurate than urea based methods and avoid problems with cardiopulmonary recirculation, but they require expensive specialized devices, which limit their applicability. Patients and Methods: We used simple dilutional method of AR based on the determination of serum potassium [K+] in two samples. A prospective study was performed in a Dialysis Unit at El Sahel Teaching hospital, Cairo, on End stage kidney disease patients on regular Hemodialysis through a functioning Arterio-venous fistula. Results: Access recirculation was found in 42% of studied patients. There were Highly Significant positive correlation between access recirculation, pre / post dialysis blood urea, basal k, and parathyroid hormone level. In addition, there were highly significant negative correlation between AR, Urea reduction ratio and KT/V. Conclusion and Recommendations: Potassium dilution method is one of the most simple, specific, and economical way to measure access recirculation and can easily be performed in any dialysis unit. We recommend more research should be done about hemodialysis adequacy, access recirculation and how to improve it.