Evaluation of partial pressure CO2 change in the dialyzer blood inlet during hemodialysis as a measure of vascular access recirculation

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-06-28 DOI:10.1111/hdi.13109

Silverio Rotondi, Adolfo Perrotta, Giovanni Pintus, Laura Capasso, Marzia Pasquali, Alessio Farcomeni, Emanuela Paoloni, Sandro Mazzaferro, Lida Tartaglione

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Abstract

Introduction

Vascular access recirculation during hemodialysis is associated with reduced effectiveness and worse survival outcomes. To evaluate recirculation, an increase in pCO₂ in the blood of the arterial line during hemodialysis (threshold of 4.5 mmHg) was proposed. The blood returning from the dialyzer in the venous line has significantly higher pCO₂, so in the presence of recirculation, pCO2 in the arterial blood line may increase (ΔpCO₂) during hemodialysis sessions. The aim of our study was to evaluate ΔpCO₂ as a diagnostic tool for vascular access recirculation in chronic hemodialysis patients.

Methods

We evaluated vascular access recirculation with ΔpCO₂ and compared it with the results of a urea recirculation test, which is the gold standard. ΔpCO₂ was obtained from the difference in pCO₂ in the arterial line at baseline (pCO₂T1) and after 5 min of hemodialysis (pCO₂T2). ∆pCO₂ = pCO₂T2–pCO₂T1.

Findings

In 70 hemodialysis patients (mean age: 70.52 ± 13.97 years; hemodialysis vintage of 41.36 ± 34.54, KT/V 1.4 ± 0.3), ∆pCO₂ was 4 ± 4 mmHg, and urea recirculation was 7% ± 9%. Vascular access recirculation was identified using both methods in 17 of 70 patients, who showed a ∆pCO₂ of 10 ± 5 mmHg and urea recirculation of 20% ± 9%; time in months of hemodialysis was the only difference between vascular access recirculation and non-vascular access recirculation patients (22 ± 19 vs. 46 ± 36, p: 0.05). In the non-vascular access recirculation group, the average ΔpCO₂ was 1.9 ± 2 (p: 0.001), and the urea recirculation % was 2.8 ± 3 (p: 0.001). The ΔpCO₂ correlated with the urea recirculation % (R: 0.728; p < 0.001).

Discussion

ΔpCO₂ in the arterial blood line during hemodialysis is an effective and reliable diagnostic tool for identifying recirculation of the vascular access but not its magnitude. The ΔpCO₂ test application is simple and economical and does not require special equipment.

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血液透析过程中透析器血液入口分压CO2变化作为血管通路再循环测量的评估

引言血液透析期间的血管通路再循环与疗效降低和生存结果恶化有关。为了评估再循环，血液透析期间动脉线血液中pCO2的增加（阈值4.5 mmHg）。从静脉线路中的透析器返回的血液具有显著更高的pCO2，因此在存在再循环的情况下，动脉血液线路中的pCO2可能在血液透析期间增加（ΔpCO2）。我们研究的目的是评估ΔpCO2作为慢性血液透析患者血管通路再循环的诊断工具。方法我们用ΔpCO2评价血管通路再循环，并将其与金标准尿素再循环试验的结果进行比较。ΔpCO2是从基线（pCO2T1）和5 血液透析分钟数（pCO2T2）。∆pCO2 = pCO2T2–pCO2T1。70名血液透析患者（平均年龄：70.52 ± 13.97 年；血液透析年份41.36 ± 34.54，KT/V 1.4 ± 0.3），∆pCO2为4 ± 4. mmHg，尿素再循环为7% ± 9%。在70名患者中的17名患者中，使用这两种方法确定了血管通路再循环，这些患者的∆pCO2为10 ± 5. mmHg和尿素再循环20% ± 9%；血液透析的月数是血管通路再循环和非血管通路再循环患者之间的唯一差异（22 ± 19对46 ± 36，p：0.05）。在非血管通路再循环组中，平均ΔpCO2为1.9 ± 2（p：0.001），尿素再循环率为2.8 ± ΔpCO2与尿素再循环百分比相关（R:0.728；p <； 0.001）。讨论血液透析期间动脉血线中的ΔpCO2是一种有效和可靠的诊断工具，用于识别血管通路的再循环，但不是其大小。ΔpCO2测试应用简单经济，不需要特殊设备。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.