Nephrology Dialysis Transplantation, Vol 13, Issue 3 739-744, Copyright © 1998 by Oxford University Press
D Schneditz, Z Fan, A Kaufman and N Levin
Background: Access blood flow (Qac) is considered a
useful indicator in the surveillance of haemodialysis access function.
However, changes in Qac may be due to changes in blood pressure and/or to
changes in access resistance (AR). Methods: Weekly
readings of Qac, cardiac output, and arterial blood pressure measured early
and late during haemodialysis were obtained in 11 patients for a period of
3 weeks. Qac was determined from thermodilution of extracorporeal blood
returning to the patient with reversed placement of blood lines and by
measurement of arterial and venous blood temperatures in the extracorporeal
circulation. Data are given as mean±SE.
Results: Qac dropped as mean arterial pressure (MAP)
and total peripheral resistance (TPR) decreased, but increased when MAP and
TPR increased. Linear regressions between the change in access flow and the
change in MAP (&Dgr;Qac%=0.80*&Dgr;MAP%-1.6,
r2=0.39), and the change in TPR
(&Dgr;Qac=0.54*&Dgr;TPR%-9.2,
r2=0.35) respectively, were significant
(P<0.001). Whereas Qac significantly decreased
(-8.4±3.3%, P<0.01) during the same treatment. AR
remained unchanged (4.7±3.2%; P=NS). AR for all studies was
16.5±1.0 peripheral resistance units
(1PRU=2.226 kPa min l-1). There
was a trend for resistance to increase (5.1±2.6%, P=NS) and for
flow to decrease (-6.1±2.3%, P=NS) during the 3 weeks of the
study. Conclusion: Qac measured during haemodialysis
is variable and depends on haemodynamics, but AR is constant. AR is related
to the physical structure of the peripheral access. Because of its
intradialytic stability AR may be better suited as an indicator of access
function. Key words: access blood flow; access
resistance; blood pressure; total peripheral resistance; vascular access
TECHNICAL REPORT
Stability of access resistance during haemodialysis
Renal Research Institute and Division of Nephrology and Hypertension, Department of Medicine at Beth Israel Medical Center in New York, NY, USA; Corresponding author at: Renal Research Institute, Yorkville Dialysis, 1555 3rd Avenue, 2nd floor, New York, NY 10128, USA
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