scholarly journals P1423INCREASED BLOOD FLOW RATE IN HIGH-FLUX HAEMODIALYSIS - IS IT RELEVANT FOR PHOSPHORUS REMOVAL IN HAEMODIALYSIS PATIENTS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nikolina Smokovska ◽  
Olivera Stojceva-Taneva ◽  
Mence Nedelkoska ◽  
Nadica Misovska ◽  
Nikola Josimovski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Function ◽  
Patient Group ◽  
Flow Rate ◽  
Phosphorus Removal ◽  
Blood Flow Rate ◽  
Phosphate Binders ◽  
Average Dose ◽  
High Flux ◽  
Urea Clearance

Abstract Background and Aims High-flux haemodialysis (HD), beside other uremic solutes harmful for patients, controls the level of phosphorus, major factor for HD-related morbidity and mortality. First line in phosphorus control in HD patients is dietary phosphorus intake reduction, whereas its’ removal is undervalued by hemodialysis. The primary objective was to analyse whether change in the rate of blood flow is relevant in phosphorus removal in HD patients. Second objective was to evaluate other variables impacted by higher blood flow rates. Method Retrospective study was conducted enrolling 80 patients from a single center in a period of 12 months. In the first six months, all patients were on lower blood flow rate (LBFR group) than the same patient group was switched to a higher blood flow rate in the following six months (HBFR group). Demographic, clinical and laboratory variables were collected and intra/inter-patient group analysis was performed. Results Forty-seven patients were male, and 41.3% were female. Mean age of the study population was 61.2±13.47 years (males 60.3±13.38, females 62.4±13.68). Mean dialysis vintage was 63.31±66.57 months. The average real blood flow rate in LBFR group was 290.75±19.65 ml/min (median 285.34 ml/min), 344.87±9.12 ml/min in HBFR group (median 339 ml/min), p=0.0002. The level of phosphorus in LBFR group was 1.52±0.03 mmol/L, and 1.45±0.04 in HBFR group, p=0.007. Other variables that significantly showed improvement following the increase of blood flow rate were eKT/V (p=0.0006), urea clearance (p=0.02) and transferrin saturation (p=0.04). The level of post-HD urea (p=0.02) and body surface area (p=0.04) were decreased. Weekly EPO dosage decrease in HBFR group (p=0.02) was not correlated with increased iron sucrose administration (LBFR group 59.99±36.18 mg/wk, HBFR group 65.8±28.7, p=0.45). There were no significant changes related to cardiac function; systolic (p=0.44) and diastolic pressure (p=0.36), mean arterial (p=0.43) and pulse pressure (p=0.26) remained in reference range. Also, the average dose of calcium-based phosphate binders did not change significantly (p=0.34). Conclusion This study showed that increased blood flow rate in HD patients reduces phosphorus and EPO consumption, improves urea clearance without significant impact on cardiac function and calcium overload with calcium-based phosphate binders.

The Effect of Hematocrit on the Clearance of Small Molecules during Hemodialysis

1983 ◽  
Vol 6 (3) ◽  
pp. 127-130 ◽  
Author(s):  
C. Woffindin ◽  
N.A. Hoenich ◽  
D.N.S. Kerr
Keyword(s):  
Blood Flow ◽  
Regression Analysis ◽  
Small Molecules ◽  
Flat Plate ◽  
Flow Rate ◽  
Distribution Curve ◽  
Blood Flow Rate ◽  
Hollow Fibre ◽  
Urea Clearance ◽  
Flow Rates

Data collected during the evaluation of a series of hemodialysers were analysed to see the effect of hematocrit on the clearance of urea and creatinine. All evaluations were performed on patients with a range of hematocrits with a mean close to 20%. The urea clearance of those in the upper half of the distribution curve (mean hematocrit 29.4%) was not significantly different from that of patients in the lower half of the distribution curve (mean hematocrit 16.9%) whether the clearance was studied at high or low blood flow rates and with hollow fibre or flat plate disposable hemodialysers. Likewise, there was no correlation between hematocrit and urea clearance by regression analysis. In contrast, the clearance of creatinine was affected by hematocrit being greater at lower hematocrit values. This difference was independent of blood flow rate and dialyser type and was confirmed by regression analysis.

Blood Flow Rate and Access Recirculation in Hemodialysis

1992 ◽  
Vol 15 (8) ◽  
pp. 470-474 ◽  
Author(s):  
I.D. Daniels ◽  
G.M. Berlyne ◽  
R.H. Barth
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Blood Pump ◽  
Concomitant Increase ◽  
Urea Clearance ◽  
Extracorporeal Blood

We studied the effect of extracorporeal blood flow rate (BFR) on access recirculation (recirc) in 19 hemodialysis patients. BUN was determined in simultaneous peripheral (P), arterial (A), and venous (V) blood obtained at BFRs of 200, 400 and 600 ml/min. Percent recirc was calculated for each BFR using the formula (P-A) / (P-V) X 100. Venous drip-chamber (VP) and pre-blood-pump (AP) pressures were measured at each BFR. Fistulograms were performed in 10 patients, and stenoses were identified in 5, all at the proximal (arterial) end of the access. Recirc increased with increasing BFR from 200 to 400 ml/min but increased little from 400 to 600 ml/min. At all BFRs recirc in the stenotic patients was higher than that of non-stenotic or unstudied patients. Urea clearance, corrected for recirc, rose with blood flow both in stenotic and non-stenotic patients. There were no differences in AP or in VP between stenotic and non-stenotic patients. At BFR ≥ 400 ml/min, a recirc threshold of 15% identified stenoses with sensitivity 100% and specificity 71%. We conclude (1) recirc increases with increasing BFR but not enough to outweight the concomitant increase in urea clearance; (2) significant access stenosis and recirc may be present even with low VP; (3) recirc was associated with arterial side stenoses; (4) at BFR ≥ 400 ml/min, access stenosis is associated with recirc > 15%.

Effect of blood flow rate on internal filtration in a high-flux dialyzer with polysulfone membrane

2012 ◽  
Vol 15 (3) ◽  
pp. 266-271 ◽  
Author(s):  
Ryoichi Sakiyama ◽  
Isamu Ishimori ◽  
Takashi Akiba ◽  
Michio Mineshima
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
High Flux ◽  
Polysulfone Membrane

The Effect of Furosemide on the Intrarenal Blood Flow Distribution in the Dog

1972 ◽  
Vol 50 (8) ◽  
pp. 774-783 ◽  
Author(s):  
Serge Carrière ◽  
Michel Desrosiers ◽  
Jacques Friborg ◽  
Michèle Gagnan Brunette
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Urine Volume ◽  
Flow Distribution ◽  
Blood Flow Rate ◽  
Initial Distribution ◽  
Blood Flow Distribution ◽  
Intrarenal Blood Flow ◽  
Femoral Blood ◽  
Furosemide Administration

Furosemide (40 μg/min) was perfused directly into the renal artery of dogs in whom the femoral blood pressure was reduced (80 mm Hg) by aortic clamping above the renal arteries. This maneuver, which does not influence the intrarenal blood flow distribution, produced significant decreases of the urine volume, natriuresis, Ccreat, and CPAH, and prevented the marked diuresis normally produced by furosemide. Therefore the chances that systemic physiological changes occurred, secondary to large fluid movements, were minimized. In those conditions, however, furosemide produced a significant increase of the urine output and sodium excretion in the experimental kidney whereas Ccreat and CPAH were not affected. The outer cortical blood flow rate (ml/100 g-min) was modified neither by aortic constriction (562 ± 68 versus 569 ± 83) nor by the subsequent administration of furosemide (424 ± 70). The blood flow rate of the outer medulla in these three conditions remained unchanged (147 ± 52 versus 171 ± 44 versus 159 ± 54). The initial distribution of the radioactivity in each compartment remained comparable in the three conditions. In parallel with the results from the krypton-85 disappearance curves, the autoradiograms, silicone rubber casts, and EPAH did not suggest any change in the renal blood flow distribution secondary to furosemide administration.

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