Objective To explore the relationship between the blood pressure and pumped blood flow rate and the blood flow rate in fistula (access flow, Qa) during hemodialysis sessions. Method The electronic sphygmomanometer and hand-held Doppler ultrasound apparatus were used to measure blood pressure and Qa before hemodialysis, within 30 minutes of the hemodialysis session at blood flow rate of 200 ml/min, 250 ml/min and 300 ml/min, at the 2nd hour and 4th hour (within 20 minutes before end of the sessions) of the hemodialysis session. Result A total of 104 maintenance hemodialysis patients were enrolled in this study. We found that ①Qa and the change rate of mean arterial pressure (MAP) were positively correlated both at the first stage of hemodialysis (0～2nd hours; r=0.447, P<0.001) and the second stage of hemodialysis (2nd～4th hours; r=0.355, P<0.001); ②MAP and Qa were statistically different between the values before dialysis, at the 2nd hour of dialysis, and at the 4th hour of dialysis (F=77.068 and 32.887, P<0.001); ③MAP decreased by 14.593 mmHg (95% CI 11.613～17.572, P<0.001) and Qa decreased by 105.853 ml/min (95% CI 72.757～138.948, P< 0.001) at the 4th hour of dialysis, as compared those before dialysis; ④the linear fitting between Qa change rate (y) and MAP change rate (x) derived an equation of y=0.75x (P=0.000); and ⑤the difference between Qa and increased pumped blood flow rate had no statistical significance (F=2.352, P=0.099). Conclusions During hemodialysis sessions, Qa decreases along with the decrease of MAP; when MAP decreases by 10%, Qa will decrease by 7.5%. Qa is unrelated to the pumped blood flow rate.
ZHAO Pei-Nan
,
RUAN Lin
,
LI Wen
,
XU Yuan-Kai
,
NIU Zhe-Li
,
YANG Yan-Li
,
ZHANG Li-Hong
. Study on the relationship between the blood pressure and pumped blood flow rate and the blood flow rate in fistula during hemodialysis[J]. Chinese Journal of Blood Purification, 2023
, 22(08)
: 629
-632
.
DOI: doi:10.3969/j.issn.1671-4091.2023.08.014
[1]. Zhao X, Niu Q, Gan L, et al. Baseline data report of the China dialysis outcomes and practice patterns study (DOPPS)[J]. Sci Rep, 2021, 11(1): 1-10. DOI: 10.1038/s41598-020-79531-4.
[2]. 金其庄, 王玉柱, 叶朝阳, 等.中国血液透析用血管通路专家共识（第2版）[J]. 中国血液净化, 2019, 18(6): 365-381. DOI: 10.3969/j.issn.1671-4091.2019.06.001
[3]. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update [J]. Am J Kidney Dis, 2020, 75(4): S1-S164. DOI: 10.1053/j.ajkd.2019.12.001.
[4]. Kudlicka J, Kavan J, Tuka V, et al. More precise diagnosis of access stenosis: ultrasonography versus angiography[J]. J Vasc Access, 2012, 13(3): 310-314. DOI: 10.5301/jva.5000047.
[5]. Aragoncillo I, Abad S, Caldés S, et al. Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial [J]. J Vasc Access, 2017, 18(4): 352-358. DOI: 10.5301/jva.5000700.
[6]. Malik J, Lomonte C, Meola M, et al. The role of Doppler ultrasonography in vascular access surveillance-controversies continue[J]. J Vasc Access, 2021, 22(1): 63-70. DOI: 10.1177/1129729820928174.
[7]. Sands J, Glidden D, Miranda C. Access flow measured during hemodialysis[J]. ASAIO J, 1996, 42(5): M530-532. DOI: 10.1097/00002480-199609000-00042.
[8]. Schneditz D, Fan Z, Kaufman A, et al. Stability of access resistance during haemodialysis[J]. Nephrol Dial Transplant, 1998, 13(3): 739-744. DOI: 10.1093/ndt/13.3.739.
[9]. Park HS, Kim WJ, Choi J, et al. The effect of vascular access type on intra-access flow volume during hemodialysis[J]. J Vasc Access, 2019, 20(6): 746-751. DOI: 10.1177/1129729819850942.
[10]. Rehman SU, Pupim LB, Shyr Y, et al. Intradialytic serial vascular access flow measurements[J]. Am J Kidney Dis, 1999, 34(3): 471-477. DOI: 10.1016/s0272-6386(99)70074-0.
[11]. 车霞静，严玉澄，倪兆慧, 等. 超声稀释法监测血液透析患者的内瘘功能[J]. 中华肾脏病杂志, 2007, 23(08): 502-504.
[12]. Krivitski NM. Novel method to measure access flow during hemodialysis by ultrasound velocity dilution technique. ASAIO Journal (American Society for Artificial Internal Organs: 1992), 1995, 41(3): M741-5.
[13]. 华参, 叶朝阳, 李玲玲, 等. GPT法和超声稀释法在动静脉内瘘流量监测中的应用和比较[J]. 中国血液净化, 2007, 6(7): 376-378.
[14]. 车霞静, 严玉澄, 倪兆慧, 等. 超声稀释法监测血液透析患者的内瘘功能[J]. 中华肾脏病杂志, 2007, 23(8): 502-504.
[15]. 车霞静, 倪兆慧, 严玉澄, 等. 血液透析患者的内瘘血流量在预测内瘘预后中的作用[J]. 中国血液净化, 2009, 8(12): 669-672.
[16]. 白丽, 王立燕, 孟宪华, 等. 血液透析泵控血流量对动静脉内瘘血流量的影响[J]. 中国血液净化, 2009, 8(6): 313-315.
[17]. Hassell DR, van der Sande FM, Kooman JP, et al. Optimizing dialysis dose by increasing blood flow rate in patients with reduced vascular-access flow rate[J]. Am J Kidney Dis, 2001, 38(5): 948-955. DOI: 10.1053/ajkd.2001.28580.
[18]. Zhao X, Niu Q, Gan L, et al. Blood flow rate: An independent risk factor of mortality in Chinese hemodialysis patients[J]. Semin Dial, 2022, 35(3): 251-257. DOI: 10.1111/sdi.13023.
