Fistula dysfunction: Effect on rapid hemodialysis

Deirdre M. Collins, Michael B. Lambert, John P. Middleton, Rebecca K. Proctor, Charles J. Davidson, Glenn E. Newman, Steve J. Schwab*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


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 < 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 < 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 < 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.

Original languageEnglish (US)
Pages (from-to)1292-1296
Number of pages5
JournalKidney international
Issue number5
StatePublished - May 1992

ASJC Scopus subject areas

  • Nephrology


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