Fistula dysfunction: effect on rapid hemodialysis.

Journal Article (Journal Article)

Rapid hemodialysis (Qb 400 to 500 ml/min) places considerable demands on hemodialysis vascular access. This six-month prospective study enrolled 52 patients and evaluated urea recirculation as a means of detecting fistula dysfunction. It evaluated the effects of fistula location and dialysis blood flow on urea recirculation during rapid hemodialysis and assessed the effect of rapid dialysis on fistula thrombosis. Urea recirculation increased as Qb increased from 300 to 400 ml/min (8 +/- 3% to 16 +/- 3%, P less than 0.05). The extent of urea recirculation was also fistula site dependent (radial fistulas 18 +/- 4%, upper arm fistulas 11 +/- 3%, Qb 400 ml/min, P less than 0.05). Site and blood flow dependent urea recirculations were an indicator of venous stenoses. When venous stenoses were corrected, urea recirculation rates improved (36 +/- 3% to 21 +/- 3%, P less than 0.05). There were no differences between methods of determining urea recirculation early in dialysis (contralateral arm venepuncture vs. stop flow technique; 30 to 60 min). However, at 120 minutes urea recirculation was significantly greater with the contralateral arm venepuncture technique. Venous dialysis pressure at Qb 400 ml/min had limited use as a predictor of venous stenoses unlike its value at lower Qb. Fistula thrombosis (0.26/patient year of dialysis) and fistula replacement (0.09/patient year of dialysis) were similar to our observations in a conventional hemodialysis facility where prospective correction of fistula dysfunction was also used.

Full Text

Duke Authors

Cited Authors

  • Collins, DM; Lambert, MB; Middleton, JP; Proctor, RK; Davidson, CJ; Newman, GE; Schwab, SJ

Published Date

  • May 1992

Published In

Volume / Issue

  • 41 / 5

Start / End Page

  • 1292 - 1296

PubMed ID

  • 1614044

International Standard Serial Number (ISSN)

  • 0085-2538

Digital Object Identifier (DOI)

  • 10.1038/ki.1992.192


  • eng

Conference Location

  • United States