Single-Needle Hemodialysis on Native Fistulae

Abstract

Single-needle (SN) dialysis was first described in 1964 by Twiss, who used a time-acti‐ vated mechanism with a pump and a double clamp to alternate blood through a caval catheter [1]. As a result of this publication, the technique of SN-hemodialysis on catheter has been widely disseminated and reported in publications primarily in the context of acute renal failure especially in post-operative cases [2]. In the 1980’s, the work of Bel‐ gian authors allowed the development of the chronic hemodialysis technic in unipunc‐ ture particularly in the Benelux countries [3-5]. Vanholder and colleagues using a specific canula and a twin pump-head SN system showed that dialysis efficiency was at least as good as with conventional double-needle (DN) hemodialysis, based on Kt/V, the hema‐ tocrit and nerve conduction [3-4]. They also showed that the five-year fistula survival rate was 74%, a figure far better than with conventional DN hemodialysis [5]. SN dialy‐ sis failed to gain popularity, however, with the exception of the Benelux countries and recently Asia, and has been confined to specific situations such as the use of a single-lu‐ men catheter, and when temporary and reversible problems of vascular access arise [6, 7]. Nevertheless, many nephrologists and dialysis nurses are reluctant to use SN dialysis, even in cases of problematic vascular access for fear of incidents or underdialysis [7]. The technique of SN-dialysis with a double-pump (Figure 1) must be differentiated from the use of an alternating clamp which should be reserved for the exceptional situation of termination of a dialysis session in the event of an incident on the native fistula on a simple-pump generator.