シャント血流量と再循環指数の検討

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  • Study on shunt blood flow volume and fractional recirculation.

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One of the most important determinants of high performance dialysis is the status of blood access (A-V shunt). In this study, we assessed the functional status of A-V shunts by two methods, shunt blood flow volume (QB) by the pulse doppler method and determination of fractional recirculation (R) based on the blood urea nitrogen value and serum level of creatinine. The subjects included 32 patients on maintenance hemodialysis. The blood flow rate in the brachial artery was 55.0-576.0ml/min (303.0±152.1ml/min) on the shunt side and 28.3-235.0ml/min (67.7±44.6ml/min) on the opposite side. QB, which was calculated mathematically by deducting from the two measurements, was 15.4-466.2ml/min (238.5±137.8ml/min). In addition, a comparative study of QB was done in two patient subgroups according to R values. QB in the patient subgroup having an R value greater than 0.15 was significantly lower than that in patients with R values below 0.15, i.e. 91.6±42.8ml/min vs. 259.4±133.9ml/min, respectively (p<0.02). Moreover, a significant negative correlation between QB and the R value (r=-0.658, p<0.001) was found. Based on those results, we conclude that the determination of R value is useful for evaluating A-V shunts from a practical viewpoint, which is assumed to be essential for achieving high performance dialysis.

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