Does the extracorporeal blood flow affect survival of the arteriovenous vascular access?

Ponce, Pedro; Marcelli, Daniele; Scholz, Caecilia; Wehmeyer, Wolfgang; Gonçalves, Pedro Araújo; Grassmann, Aileen; Brand, Katharina; Canaud, Bernard

doi:10.1111/hdi.12240

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…These results indicate that optimal blood flow rates between 300 and 400 mL/min exist, where the risk of IH can be minimized. This is in agreement with the results of Ponce et al who found that patients were at a significantly higher risk of vascular access failure for blood flow rates below 310 mL/min and greater than 400 mL/min.…”

Section: Discussionsupporting

confidence: 93%

Computational Fluid Dynamic Analysis of the Hemodialysis Plastic Cannula

et al. 2017

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The jet of fluid returning to the patient through a hemodialysis venous needle has previously been reported as a potential source of endothelial damage which can lead to intimal hyperplasia (IH) in arteriovenous fistulae (AVF). Metal needles are the current standard practice for accessing the vascular system in hemodialysis. However, plastic cannulae have been used in Japan for 30 years. This study utilized computational fluid dynamics to analyze the hemodynamics of blood exiting a plastic cannula and determined the optimal placement and blood flow rate. Transient simulations were run using a 15G Argyle Safety Fistula Cannula with Anti-Reflux Valve inserted into an idealized cephalic vein. The cannula tip was fixed at three different locations within the vein (upper third, middle, and lower third) with blood flow rates of 200 mL/min, 300 mL/min, and 400 mL/min imposed. The high degree of jet break down immediately after exiting the cannula was attributed to the staggered side hole arrangement, position of the cannula in the vein, and the imposed blood flow rate. Elevated levels of wall shear stress which may lead to IH were identified at the site of jet impingement on the vein floor as well as regions of high residency time. The risk of IH may be minimized by enhancing the breakdown of the jet through the use of optimal blood flow rates between 300 and 400 mL/min and ensuring the cannula tip is placed away from the walls of the vein.

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Section: Discussionsupporting

confidence: 93%

Computational Fluid Dynamic Analysis of the Hemodialysis Plastic Cannula

et al. 2017

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“…This is linked to the transitional flow in the VN, where Reynolds numbers range between 924 and 1847, indicating that an optimum blood flow rate exists which can minimize RRT. Ponce et al [33] showed patients were at a significantly higher risk of AVF failure at blood flow rates below 310 ml/min and greater than 400 ml/min. Sharp needle angles and a needle tip placed near the roof of the vein also produced regions of higher residency time as these parameters influenced the production of secondary flows.…”

Section: Discussionmentioning

confidence: 99%

Computational Model of the Arterial and Venous Needle During Hemodialysis

Fulker

Simmons

Barber

2016

Journal of Biomechanical Engineering

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Arteriovenous fistulae (AVF) are the favored choice of vascular access but still have poor long-term success. Hemodynamic parameters play an important role in vascular health and have been linked to the development of intimal hyperplasia (IH), a pathological growth of the blood vessel initiated by injury. This study aimed to investigate the hemodynamics surrounding the arterial needle (AN) and venous needle (VN), using computational fluid dynamics. A range of blood flow rates, needle positions, and needle orientations were examined. Disturbed flows were found around AN tip in both antegrade and retrograde orientations, which result in regions of high residency time on the surface of the vein and may disrupt endothelial function. Conversely, a high speed jet exits the VN, which produced high wall shear stresses (WSSs) at the point of impingement which can damage the endothelium. The secondary flows produced by jet dissipation also resulted in regions of high residency time, which may influence endothelial structure, leading to IH. The use of shallow needle angles, a blood flow rate of approximately 300 ml/min, and placement of the needle tip away from the walls of the vein mitigates this risk.

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“…Furthermore, it seems important to mention that the increase of Qs is not devoid of risks, especially the increase in the risk of dysfunction of the arteriovenous fistula [12] and an increase in the rate of formation of microbubbles [13], most of which are blocked by bubble traps under conventional HD and missing in the NxStageR system 1 device.…”

Section: Discussionmentioning

confidence: 99%

Does the Blood Pump Flow Rate have an Impact on the Dialysis Dose During Low Dialysate Flow Rate Hemodialysis?

et al. 2018

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We conducted a prospective study to assess the impact of the blood pump flow rate (BFR) on the dialysis dose with a low dialysate flow rate. Seventeen patients were observed for 3 short hemodialysis sessions in which only the BFR was altered (300,350 and 450 mL/min). Kt/V urea increased from 0.54 ± 0.10 to 0.58 ± 0.08 and 0.61 ± 0.09 for BFR of 300, 400 and 450 mL/min. For the same BFR variations, the reduction ratio (RR) of β2microglobulin increased from 0.40 ± 0.07 to 0.45 ± 0.06 and 0.48 ± 0.06 and the RR phosphorus increased from 0.46 ± 0.1 to 0.48 ± 0.08 and 0.49 ± 0.07. In bivariate analysis accounting for repeated observations, an increasing BFR resulted in an increase in spKt/V (0.048 per 100 mL/min increment in BPR [p < 0.05, 95% CI (0.03–0.06)]) and an increase in the RR β2m (5% per 100 mL/min increment in BPR [p < 0.05, 95% CI (0.03–0.07)]). An increasing BFR with low dialysate improves the removal of urea and β2m but with a potentially limited clinical impact.

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Does the extracorporeal blood flow affect survival of the arteriovenous vascular access?

Cited by 11 publications

References 28 publications

Computational Fluid Dynamic Analysis of the Hemodialysis Plastic Cannula

Computational Fluid Dynamic Analysis of the Hemodialysis Plastic Cannula

Computational Model of the Arterial and Venous Needle During Hemodialysis

Does the Blood Pump Flow Rate have an Impact on the Dialysis Dose During Low Dialysate Flow Rate Hemodialysis?

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