Reversed connection of cuffed, tunneled, dual-lumen catheters with increased blood flow rate maintains the adequacy of delivered dialysis despite the higher access recirculation.

Abstract

Reversing the connection mode of permanent dual-lumen dialysis catheters results in higher access recirculation that may compromise the dialysis adequacy. The purpose of this study is to investigate the effect of reversed-connected dialysis with a higher versus a standard blood flow rate (Qb) on adequacy parameters and access recirculation. In a cross-over design, 46 prevalent dialysis patients with a properly functioning cuffed, tunneled, dual-lumen catheter were evaluated in three consecutive mid-week dialysis sessions. At baseline, participants were evaluated under standardized conditions (correct connection, Qb = 300ml/min). In Phase A, dialysis was performed with reversed connection and Qb = 300ml/min. In Phase B, dialysis was performed with reversed connection and Qb = 400ml/min. The sequence of evaluations (Phase A and B or vise verse) was randomized. All other dialysis-related parameters were unchanged in all three occasions. As expected, compared with baseline, reversed-connected dialysis in Phase A resulted in lower URR and spKt/V, and in a higher recirculation rate. Compared with baseline, reversed-connected dialysis with a higher Qb in Phase B resulted in an even higher recirculation rate, but the parameters of dialysis adequacy were not different. Increase in Qb from 300 to 400ml/min resulted in an improvement of the dialysis adequacy (URR: 64.1 ± 7.8% vs. 70.6 ± 8.2%, P < 0.001; spKt/V: 1.22 ± 0.3 vs. 1.45 ± 0.3, P < 0.001) despite the higher recirculation rate. This study suggests that reversed-connected dialysis with increasing Qb maintains the adequacy of the delivered dialysis despite the compensatory increase in recirculation.