Why Does Vascular Access Dysfunction Occur despite Brachial Artery Blood Flow Being Higher than Preset Blood Flow?

J, Ono; Oiwa, Takushi; Ogasawara, Yasuo; Mochizuki, Seiichi

doi:10.3390/kidneydial2010005

Cited by 1 publication

(1 citation statement)

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“…Ono et al stated that it is important to focus on the blood flow waveform pattern rather than just the average shunt blood flow value to explain the shunt dysfunction from the verification using the experimental circuit. In addition, they speculated that recirculation or decreased actual blood removal flow would occur when the diastolic shunt flow falls below the set blood flow [16]. This study revealed that higher recirculation was observed in the diastolic phase, which has slower blood flow.…”

Section: Discussionmentioning

confidence: 78%

Relationship between resistance index and recirculation rate in vascular access

et al. 2022

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Background The state of vascular access affects the efficiency of hemodialysis. Poor blood flow of vascular access causes recirculation, which reduces treatment efficiency. In the clinical setting, the resistance index (RI) is a commonly used parameter to evaluate the state of vascular access. However, there are few reports investigating the direct relationship between RI and the recirculation rate. In this study, the relationship between RI and the recirculation rate was investigated using computational fluid dynamics analysis. Methods We created a three-dimensional model that mimics vascular access in hemodialysis patients. Next, we input various blood flow waveforms (RI 0.00, 0.50, 0.60, 0.80, and 0.94) into the vascular model. Then, two needles were punctured into the blood vessel model. Blood was removed from the vessel by one needle at a rate of 200 ml/min and returned by the other needle at the same speed. The recirculation rate was calculated using the backflow from the blood return needle. Results The recirculation rates for the blood flow waveforms of RI 0.00, 0.50, 0.60, 0.80, and 0.94 were 0.00%, 0.29%, 0.44%, 11.6%, and 28.1%, respectively. The recirculation rate was higher for blood flow with higher RI. In addition, more recirculation occurred during the diastolic phase, when blood flow was slow. Conclusions When the minimum blood flow was slower than the hemodialysis blood removal speed, both backflow and the recirculation rate increased. Sufficient diastolic blood flow needs to be maintained to suppress recirculation.

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Section: Discussionmentioning

confidence: 78%