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Arteriovenous fistula recirculation in hemodialysis


The delivery of hemodialysis is defined by the dialysis prescription. This prescription includes the duration of treatment, dialysate flow, blood flow, and the specific dialyzer. However, many patients are underdialyzed due, in part, to problems with hemodialysis access recirculation, resulting in dialysis delivery being less than that prescribed [1]. (See "Prescribed versus delivered dialysis: Importance of dialysis time".)

One setting in which the presence of significant recirculation should be suspected is when there is an inadequate reduction in the postdialysis blood urea nitrogen (BUN), which should be less than 40 percent of the predialysis value. (See "Prescribing and assessing adequate hemodialysis", section on 'Alternatives to Kt/V'.)

Hemodialysis access recirculation occurs when dialyzed blood returning through the venous needle reenters the extracorporeal circuit through the arterial needle, rather than returning to the systemic circulation. It is important to measure hemodialysis access recirculation for two reasons:

The reentry of dialyzed blood into the extracorporeal circuit reduces solute concentration gradients across the dialysis membrane by mixing already dialyzed with undialyzed blood. As a result, the efficiency of dialysis is reduced. High degrees of recirculation can lead to a significant discrepancy between the amount of hemodialysis prescribed (prescribed Kt/V urea) and the amount of hemodialysis delivered (delivered Kt/V urea). (See "Prescribed versus delivered dialysis: Importance of dialysis time".)

High degrees of access recirculation indicate the presence of access stenoses, the most common cause of access thrombosis. Prospective identification and treatment of access stenoses improves long-term access patency rates. (See "Overview of the treatment of stenosis and thrombotic complications of hemodialysis arteriovenous grafts and fistulas".)


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Literature review current through: Aug 2014. | This topic last updated: Dec 18, 2012.
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