Determination of access blood flow from ionic dialysance: Theory and validation

Mercadal, Lucile; Hamani, Aziz; Béné, Bernard; Petitclerc, Thierry
October 1999
Kidney International;Oct1999, Vol. 56 Issue 4, p1560
Academic Journal
Determination of access blood flow from ionic dialysance: Theory and validation. Background. Several noninvasive techniques have been recently developed for calculating blood flow rate of vascular access in hemodialyzed patients from the on-line measurement of recirculation ratio by injecting a saline bolus when the blood lines are reversed. Here we describe a new noninvasive method based on ionic dialysance measurements without the need of a saline bolus. Methods. Mathematical modeling allows to calculate blood flow in vascular access (QA ) from the recirculation ratio (Rrev ) measured when the blood lines are reversed, without the need to stop ultrafiltration, by using the formula: QA = (QB -QF ) 1 -Rrev /Rrev where QB is the blood flow at the dialyzer inlet and QF the ultrafiltration rate. Because the ionic dialysance takes recirculation into account, we tested a new method to assess QA from the measurement of ionic dialysance at normal (D) and reverse (Drev ) positions of the blood lines for the same QB . Assuming the absence of access recirculation at normal position of the blood lines, mathematical modeling provides the following relationship: QA = (D - QF )Drev /D - Drev . The estimation of QA from measurement of ionic dialysance (QA-ID ) was compared in 28 patients to the estimation of QA by ultrasound dilution technique (QA-US ). Results. The two methods were strongly correlated (QA-ID = 1.24 * QA-US , r 2 = 0.86, P < 0.0001). The difference between QA-ID and QA-US was 107 ± 387 ml/min (mean ±sd). Conclusions. Our method provides a valuable estimation of the vascular access flow and is fully noninvasive, easy to perform (no need of bolus injection and of accurate...


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