Ultrafiltration method for measuring vascular access flow rates during hemodialysis

Ultrafiltration method for measuring vascular access flow rates during hemodialysis.BackgroundThe vascular access blood flow rate (QA) has been shown to be an important predictor of vascular access failure; therefore, the routine measurement of QA may prove to be a useful clinical method of vascular access assessment.MethodsWe have developed a new ultrafiltration (UF) method for determining QA during HD from changes in arterial hematocrit (H) after abrupt changes in the UF rate with the dialysis blood lines in the normal (δHn) and reverse (δHr) configurations. This method accounts for cardiopulmonary recirculation and requires neither intravenous saline injections nor accurate knowledge of the dialyzer blood flow rate. Clinical studies were conducted in 65 chronic HD patients from three different dialysis programs to compare QA determined by the UF method with that determined by saline dilution using an ultrasound flow sensor.ResultsArterial H increased (P < 0.0001) after abrupt increases in the UF rate when the lines were in the normal and reverse configurations. An increase in the UF rate from the minimum setting to 1.8 liter/hr resulted in a δHn of 0.3 ± 0.2 (mean ±SD) H units and a δHr of 1.6 ± 1.0 H units. QA values determined by the UF method (1050 ± 460 ml/min) were 16 ± 25% higher (P < 0.001) than those determined by saline dilution (950 ± 440 ml/min); the calculated QA values by the UF and saline dilution methods correlated highly with each other (R = 0.92, P < 0.0001). The average coefficient of variation for duplicate measurements of QA determined by the UF method in a subset of these patients (N = 21) was approximately 10% when assessed in either the same dialysis session or consecutive sessions.ConclusionsThe results from this study show that changes in arterial H after abrupt changes in the UF rate can be used to assess QA