Varvara Kousoula1, Panagiotis I Georgianos2, Konstantinos Mavromatidis3, Christos Syrganis4, Elias Thodis5, Stylianos Panagoutsos5, Ploumis Passadakis5. 1. Therapeutiki Dialysis Unit, Chalkidikis St 77, 542 48, Thessaloniki, Greece. barbkous@hotmail.com. 2. Therapeutiki Dialysis Unit, Chalkidikis St 77, 542 48, Thessaloniki, Greece. 3. Renal Department, General Hospital of Komotini, Komotini, Greece. 4. Hemodialysis Unit, Achillopouleion General Hospital of Volos, Volos, Greece. 5. Department of Nephrology, School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece.
Abstract
PURPOSE: 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. MATERIALS AND METHODS: 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 = 300 ml/min). In Phase A, dialysis was performed with reversed connection and Qb = 300 ml/min. In Phase B, dialysis was performed with reversed connection and Qb = 400 ml/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. RESULTS: 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 400 ml/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. CONCLUSION: This study suggests that reversed-connected dialysis with increasing Qb maintains the adequacy of the delivered dialysis despite the compensatory increase in recirculation.
RCT Entities:
PURPOSE: 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. MATERIALS AND METHODS: 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 = 300 ml/min). In Phase A, dialysis was performed with reversed connection and Qb = 300 ml/min. In Phase B, dialysis was performed with reversed connection and Qb = 400 ml/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. RESULTS: 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 400 ml/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. CONCLUSION: This study suggests that reversed-connected dialysis with increasing Qb maintains the adequacy of the delivered dialysis despite the compensatory increase in recirculation.
Entities:
Keywords:
Adequacy; Central venous catheter; Dialysis; Recirculation