Renal Division, Ghent University Hospital, Ghent - Belgium.
J Nephrol. 2011 May-Jun;24(3):338-44. doi: 10.5301/JN.2011.6421.
Catheter dysfunction is a concern when using double-lumen catheters in hemodialysis (HD). Reversing the connection mode results in higher blood flows, but also enhanced recirculation. We evaluated total solute removal (TSR) of different uremic retention solutes during a complete HD session, once with reversed (RL) and once with correctly connected lines (CL).
Genius dialysis was performed in 22 HD patients at maximum blood flow (QB), once with CL and once with RL. TSR was determined for urea, creatinine, phosphate and ß2-microglobulin (ß2M). Using a kinetic model, we simulated TSR and reduction ratio (RR) for urea for different percentages of access recirculation and different QB during CL vs. RL.
RR and TSR of the tested solutes were not different in clinical practice between CL and RL. Mathematically, urea RR did not differ with CL or RL, but TSR decreased by 4.5%-23.3% when changing from CL to RL for a recirculation of 5%-25%, respectively. For a recirculation of 5%-25%, QB in RL should be increased by 6.7% and 52.0%, 8.5% and 72.0%, and 10.0% and 115.2%, respectively, for a blood flow in CL mode of 150, 200 or 250 ml/min.
Connecting patients to double-lumen dialysis catheters in RL does not impair TSR in clinical practice. Mathematically, TSR during RL was dependent upon the obtained QB and degree of recirculation. A nomogram indicating the increase in QB needed in RL to obtain equal TSR as in the CL mode, at different degrees of recirculation, is provided.
在血液透析（HD）中使用双腔导管时，导管功能障碍是一个关注点。颠倒连接模式会导致更高的血流，但也会增强再循环。我们评估了不同尿毒症潴留溶质在整个 HD 治疗过程中的总溶质清除率（TSR），一次是在反转（RL）连接模式下，一次是在正确连接的管路（CL）下。
在最大血流（QB）下，22 名 HD 患者分别进行 Genius 透析，一次是在 CL 下，一次是在 RL 下。TSR 用于确定尿素、肌酐、磷酸盐和β2-微球蛋白（β2M）。使用动力学模型，我们模拟了 CL 与 RL 下不同 Access 再循环百分比和 QB 下尿素的 TSR 和还原比（RR）。
在 CL 与 RL 下，测试溶质的 RR 和 TSR 在临床实践中没有差异。从数学上看，尿素 RR 与 CL 或 RL 没有差异，但当从 CL 切换到 RL 时，对于 5%-25%的再循环，TSR 分别降低了 4.5%-23.3%。对于 5%-25%的再循环，当 CL 模式下的 QB 为 150、200 或 250ml/min 时，RL 下的 QB 应分别增加 6.7%和 52.0%、8.5%和 72.0%以及 10.0%和 115.2%。
在 RL 下将患者连接到双腔透析导管不会损害临床实践中的 TSR。从数学上讲，RL 下的 TSR 取决于获得的 QB 和再循环程度。提供了一个图示，显示了在不同再循环程度下，RL 下需要增加 QB 以获得与 CL 模式相同的 TSR。
