Arterio-Venous Fistula Recirculation in Hemodialysis: Causes and Prevalence

Abstract

Recirculation is an important issue in hemodialysis (HD) patients as increased percent recirculation causes decreased dialysis delivery of the patients. The purpose of the study was to determine the prevalence and possible causes of recirculation in those patients. The study was a cross sectional one carried in the department of Nephrology, Ain Shams University Hospitals. A total of 100 end stage renal disease patients with arterio-venous fistula who were on HD for more than 3 months were purposively selected. The degree of recirculation was measured with urea based two needle technique method. For each patient distances between arterial and venous and distances of needles from fistula and its directions were recorded. Echocardiography and A-V fistula Colour Doppler Ultrasound were also performed for patients with high degree recirculation percent (more than 10%). The prevalence of A-V fistula recirculation was 55% with a range 0-66%. The most common factors were close proximity and improper arterial and venous needles placement. No difference was observed between diabetic and non- diabetic also between hypertensive and normotensive. A-V fistula recirculation is common occurrence in HD patients and the most common factors of recirculation are misplacement and close proximity of needles therefore emphasis should be given on education and training of HD staffs