Silverio Rotondi, Adolfo Perrotta, Giovanni Pintus, Laura Capasso, Marzia Pasquali, Alessio Farcomeni, Emanuela Paoloni, Sandro Mazzaferro, Lida Tartaglione
{"title":"血液透析过程中透析器血液入口分压CO2变化作为血管通路再循环测量的评估","authors":"Silverio Rotondi, Adolfo Perrotta, Giovanni Pintus, Laura Capasso, Marzia Pasquali, Alessio Farcomeni, Emanuela Paoloni, Sandro Mazzaferro, Lida Tartaglione","doi":"10.1111/hdi.13109","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Vascular access recirculation during hemodialysis is associated with reduced effectiveness and worse survival outcomes. To evaluate recirculation, an increase in pCO<sub>2</sub> in the blood of the arterial line during hemodialysis (threshold of 4.5 mmHg) was proposed. The blood returning from the dialyzer in the venous line has significantly higher pCO<sub>2</sub>, so in the presence of recirculation, pCO2 in the arterial blood line may increase (ΔpCO<sub>2</sub>) during hemodialysis sessions. The aim of our study was to evaluate ΔpCO<sub>2</sub> as a diagnostic tool for vascular access recirculation in chronic hemodialysis patients.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We evaluated vascular access recirculation with ΔpCO<sub>2</sub> and compared it with the results of a urea recirculation test, which is the gold standard. ΔpCO<sub>2</sub> was obtained from the difference in pCO<sub>2</sub> in the arterial line at baseline (pCO<sub>2</sub>T1) and after 5 min of hemodialysis (pCO<sub>2</sub>T2). ∆pCO<sub>2</sub> = pCO<sub>2</sub>T2–pCO<sub>2</sub>T1.</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>In 70 hemodialysis patients (mean age: 70.52 ± 13.97 years; hemodialysis vintage of 41.36 ± 34.54, KT/V 1.4 ± 0.3), ∆pCO<sub>2</sub> was 4 ± 4 mmHg, and urea recirculation was 7% ± 9%. Vascular access recirculation was identified using both methods in 17 of 70 patients, who showed a ∆pCO<sub>2</sub> of 10 ± 5 mmHg and urea recirculation of 20% ± 9%; time in months of hemodialysis was the only difference between vascular access recirculation and non-vascular access recirculation patients (22 ± 19 vs. 46 ± 36, <i>p</i>: 0.05). In the non-vascular access recirculation group, the average ΔpCO<sub>2</sub> was 1.9 ± 2 (<i>p</i>: 0.001), and the urea recirculation % was 2.8 ± 3 (<i>p</i>: 0.001). The ΔpCO<sub>2</sub> correlated with the urea recirculation % (<i>R</i>: 0.728; <i>p</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Discussion</h3>\n \n <p>ΔpCO<sub>2</sub> in the arterial blood line during hemodialysis is an effective and reliable diagnostic tool for identifying recirculation of the vascular access but not its magnitude. The ΔpCO<sub>2</sub> test application is simple and economical and does not require special equipment.</p>\n </section>\n </div>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13109","citationCount":"0","resultStr":"{\"title\":\"Evaluation of partial pressure CO2 change in the dialyzer blood inlet during hemodialysis as a measure of vascular access recirculation\",\"authors\":\"Silverio Rotondi, Adolfo Perrotta, Giovanni Pintus, Laura Capasso, Marzia Pasquali, Alessio Farcomeni, Emanuela Paoloni, Sandro Mazzaferro, Lida Tartaglione\",\"doi\":\"10.1111/hdi.13109\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Vascular access recirculation during hemodialysis is associated with reduced effectiveness and worse survival outcomes. To evaluate recirculation, an increase in pCO<sub>2</sub> in the blood of the arterial line during hemodialysis (threshold of 4.5 mmHg) was proposed. The blood returning from the dialyzer in the venous line has significantly higher pCO<sub>2</sub>, so in the presence of recirculation, pCO2 in the arterial blood line may increase (ΔpCO<sub>2</sub>) during hemodialysis sessions. The aim of our study was to evaluate ΔpCO<sub>2</sub> as a diagnostic tool for vascular access recirculation in chronic hemodialysis patients.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We evaluated vascular access recirculation with ΔpCO<sub>2</sub> and compared it with the results of a urea recirculation test, which is the gold standard. ΔpCO<sub>2</sub> was obtained from the difference in pCO<sub>2</sub> in the arterial line at baseline (pCO<sub>2</sub>T1) and after 5 min of hemodialysis (pCO<sub>2</sub>T2). ∆pCO<sub>2</sub> = pCO<sub>2</sub>T2–pCO<sub>2</sub>T1.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Findings</h3>\\n \\n <p>In 70 hemodialysis patients (mean age: 70.52 ± 13.97 years; hemodialysis vintage of 41.36 ± 34.54, KT/V 1.4 ± 0.3), ∆pCO<sub>2</sub> was 4 ± 4 mmHg, and urea recirculation was 7% ± 9%. Vascular access recirculation was identified using both methods in 17 of 70 patients, who showed a ∆pCO<sub>2</sub> of 10 ± 5 mmHg and urea recirculation of 20% ± 9%; time in months of hemodialysis was the only difference between vascular access recirculation and non-vascular access recirculation patients (22 ± 19 vs. 46 ± 36, <i>p</i>: 0.05). In the non-vascular access recirculation group, the average ΔpCO<sub>2</sub> was 1.9 ± 2 (<i>p</i>: 0.001), and the urea recirculation % was 2.8 ± 3 (<i>p</i>: 0.001). The ΔpCO<sub>2</sub> correlated with the urea recirculation % (<i>R</i>: 0.728; <i>p</i> < 0.001).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Discussion</h3>\\n \\n <p>ΔpCO<sub>2</sub> in the arterial blood line during hemodialysis is an effective and reliable diagnostic tool for identifying recirculation of the vascular access but not its magnitude. The ΔpCO<sub>2</sub> test application is simple and economical and does not require special equipment.</p>\\n </section>\\n </div>\",\"PeriodicalId\":1,\"journal\":{\"name\":\"Accounts of Chemical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":16.4000,\"publicationDate\":\"2023-06-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13109\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Accounts of Chemical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/hdi.13109\",\"RegionNum\":1,\"RegionCategory\":\"化学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MULTIDISCIPLINARY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hdi.13109","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
Evaluation of partial pressure CO2 change in the dialyzer blood inlet during hemodialysis as a measure of vascular access recirculation
Introduction
Vascular access recirculation during hemodialysis is associated with reduced effectiveness and worse survival outcomes. To evaluate recirculation, an increase in pCO2 in the blood of the arterial line during hemodialysis (threshold of 4.5 mmHg) was proposed. The blood returning from the dialyzer in the venous line has significantly higher pCO2, so in the presence of recirculation, pCO2 in the arterial blood line may increase (ΔpCO2) during hemodialysis sessions. The aim of our study was to evaluate ΔpCO2 as a diagnostic tool for vascular access recirculation in chronic hemodialysis patients.
Methods
We evaluated vascular access recirculation with ΔpCO2 and compared it with the results of a urea recirculation test, which is the gold standard. ΔpCO2 was obtained from the difference in pCO2 in the arterial line at baseline (pCO2T1) and after 5 min of hemodialysis (pCO2T2). ∆pCO2 = pCO2T2–pCO2T1.
Findings
In 70 hemodialysis patients (mean age: 70.52 ± 13.97 years; hemodialysis vintage of 41.36 ± 34.54, KT/V 1.4 ± 0.3), ∆pCO2 was 4 ± 4 mmHg, and urea recirculation was 7% ± 9%. Vascular access recirculation was identified using both methods in 17 of 70 patients, who showed a ∆pCO2 of 10 ± 5 mmHg and urea recirculation of 20% ± 9%; time in months of hemodialysis was the only difference between vascular access recirculation and non-vascular access recirculation patients (22 ± 19 vs. 46 ± 36, p: 0.05). In the non-vascular access recirculation group, the average ΔpCO2 was 1.9 ± 2 (p: 0.001), and the urea recirculation % was 2.8 ± 3 (p: 0.001). The ΔpCO2 correlated with the urea recirculation % (R: 0.728; p < 0.001).
Discussion
ΔpCO2 in the arterial blood line during hemodialysis is an effective and reliable diagnostic tool for identifying recirculation of the vascular access but not its magnitude. The ΔpCO2 test application is simple and economical and does not require special equipment.
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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