Vascular access as a determinant of adequacy of dialysis

Andrew J. Cortez, William D. Paulson, Steve J. Schwab

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Vascular accesses consist of permanent arteriovenous (AV) accesses (autogenous fistulas and synthetic grafts) and venous accesses (central venous catheters [CVCs]). AV accesses have fewer complications than venous accesses, and are therefore the preferred hemodialysis access. An important additional issue is whether the type of access influences adequacy of dialysis (i.e. Kt/V). Key limiting factors in delivering adequate Kt/V are blood pump speed (Q B), access recirculation, and treatment time. In general, AV accesses support higher QBs with less negative inflow arterial pressures than CVCs. Well-functioning AV accesses are also less likely to exhibit recirculation. Nevertheless, recirculation commonly develops when AV accesses (usually grafts) develop stenosis with decreased access blood flow. Although extension of treatment time can offset the effects of reduced QB and recirculation, this is often impractical and poorly accepted by patients. In conclusion, AV accesses are superior to venous accesses because they are less prone to complications and are more likely to deliver prescribed Kt/V within prescribed treatment time.

Original languageEnglish (US)
Pages (from-to)96-101
Number of pages6
JournalSeminars in Nephrology
Volume25
Issue number2
DOIs
StatePublished - Jan 1 2005

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Blood Vessels
Dialysis
Central Venous Catheters
Transplants
Fistula
Renal Dialysis
Arterial Pressure
Pathologic Constriction
Therapeutics

ASJC Scopus subject areas

  • Nephrology

Cite this

Vascular access as a determinant of adequacy of dialysis. / Cortez, Andrew J.; Paulson, William D.; Schwab, Steve J.

In: Seminars in Nephrology, Vol. 25, No. 2, 01.01.2005, p. 96-101.

Research output: Contribution to journalArticle

Cortez, Andrew J. ; Paulson, William D. ; Schwab, Steve J. / Vascular access as a determinant of adequacy of dialysis. In: Seminars in Nephrology. 2005 ; Vol. 25, No. 2. pp. 96-101.
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