Recirculation and adequacy of dialysis in end stage renal disease patients on regular hemodialysis at Menoufia university hospitals

Abstract

Background Early detection of vascular access complication prevents more severe conditions and reduces hospitalization periods of patients on regular hemodialysis (HD). Access recirculation (AR) is one of the tools for early evaluation of arteriovenous fistula (AVF) complication for early intervention. The aim of our study was to evaluate the AV AR as a risk factor for inadequate HD in patients with end-stage renal disease in Menoufia university hospitals. Patients and methods This is a cross-sectional study that included 300 patients on regular HD sessions at four centers at Menoufia university hospitals. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, and measurement of recirculation by urea-based method. Results This study included 300 patients on regular HD. It showed that 51.7% presented with aneurysm, whereas the infected AV access was presented in 6% of patients. AR was found in 17.7% of patients, being more frequent in patients with the left brachiocephalic AVF (37.7%), and it showed highly significant relation with duration of dialysis and duration of AVF creation. The risk factors for recirculation were the distance between arterial and venous needle sites, puncture site aneurysm, and stenosis. There were negative correlations between AR and both urea reduction ratio and KT/V and positive with both serum potassium and parathyroid hormone level. Conclusion AR in our unit was associated mainly with stenosis, aneurysm, and improper needle puncture sites, so screening for recirculation may be used as a surveillance technique for the early detection of AVF in concomitant with regular training of dialysis staff in cannulation of the AVF.