How to improve dialysis adequacy in patients with vascular access problems

Blood flow rate is a critical factor in the achievement of an adequate dialysis dose. The aim of this review is to evaluate the possibility of optimizing dialysis dose in terms of Kt/V in patients with reduced vascular access (VA) flow rate, considering effective blood flow (Qb eff), recirculation,...

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Bibliographic Details
Published in:The journal of vascular access 2006-04, Vol.7 (2), p.53-59
Main Authors: Mandolfo, S, Borlandelli, S, Ravani, P, Imbasciati, E
Format: Article
Language:English
Subjects:
Arteriovenous Shunt, Surgical
Blood Circulation
Blood Flow Velocity
Catheters, Indwelling
Dialysis Solutions
Humans
Renal Dialysis - methods
Renal Insufficiency - blood
Renal Insufficiency - physiopathology
Renal Insufficiency - surgery
Urea - blood
Urea - pharmacokinetics
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Summary:Blood flow rate is a critical factor in the achievement of an adequate dialysis dose. The aim of this review is to evaluate the possibility of optimizing dialysis dose in terms of Kt/V in patients with reduced vascular access (VA) flow rate, considering effective blood flow (Qb eff), recirculation, access flow and hemodialyzer. In patients where the achievement of adequate blood flow rates are difficult to obtain and no surgical revision is necessary, to avoid under dialysis the increase in the treatment time should be the first choice solution. If such a solution is difficult for various reasons, a forced partial blood flow recirculation, especially in central venous catheters (CVCs) with reversed lines can be useful, on condition that the dialysis session is prolonged. The possibility of increasing the efficiency of dialysis through an increase in filter clearance has to be considered. Monitoring arterial pre-pump pressure (P asp) and optimizing ratio P asp/Qb eff during hemodialysis (HD) is one possible solution to improve blood flow rates, but it is necessary to educate and involve the staff. Recent developments in a new class of highly effective hemodialyzer due to dialysate distribution, has opened up interesting opportunities in terms of dialysis adequacy in patients with reduced VA flow rate.
ISSN:1129-7298
1724-6032
DOI:10.1177/112972980600700203