Hemodialysis Kinetics 101

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Access Recirculation Debrief

August 2, 2017 itg

CLINICAL PEARLS:

The higher the blood pump flow rate, the higher the chances of access recirculation.
25% of patients with a drop in Kt/V tend to have access recirculation issues.

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Access Recirculation Debrief

Access Recirculation should be suspected when there is a significant discrepancy between prescribed and delivered dialysis dose (i.e. measured Kt/V is significantly less than expected Kt/V based on dialysis prescription).

Dialyzed blood mixes with the un-dialyzed blood in the extra corporeal circuit rather than returning to the systemic circulation.

Decreases dialysis efficiency due to decrease in solute concentration pre-filter (in the arterial circuit).

25% of patients with a drop in Kt/V tend to have access recirculation issues.

20% recirculation happens with reverse needle placements.

Usually close needle placements are an uncommon cause for recirculation as long as fistula flow is greater than the blood pump flow rate.

Access recirculation is a late marker for access stenosis so it is not ideal for AVF monitoring.

The 'key' to KT/V

Basics

Kt/Vurea

Clinical Cases

Namrata Krishnan, MD

Yale University School of Medicine
Veterans Affairs Medical Center
2017