Arterial line pressure control enhanced extracorporeal blood flow prescription in hemodialysis patients

• Main Authors: Rosales Laura, Flores Nelly, De-La-Cruz Guadalupe, Magaña Salvador, Herrera–Felix Juan P, Mariscal Alfonso, Mora-Bravo Franklin G, Franco Martha, Pérez-Grovas Héctor
• Format: Article
• Language: English
• Published: BMC 2008-11-01
• Series: BMC Nephrology
• Online Access: http://www.biomedcentral.com/1471-2369/9/15

<p>Abstract</p> <p>Background</p> <p>In hemodialysis, extracorporeal blood flow (Qb) recommendation is 300–500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP).</p> <p>Methods</p> <p>This prospective study included 72 patients with catheter Group 1 (G1), 1877 treatments and 35 arterio-venous (AV) fistulae Group 2 (G2), 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250 mmHg. We measured ionic clearance (IK: mL/min), access recirculation, DALP (mmHg) and Qb (mL/min). Six prescription zones were identified: from an optimal A zone (Qb > 400, DALP -200 to -250) to zones with lower Qb E (Qb < 300, DALP -200 to -250) and F (Qb < 300, DALP > -199).</p> <p>Results</p> <p>Treatments distribution in A was 695 (37%) in G1 vs. 704 (37.7%) in G2 (<it>P </it>= 0.7). In B 150 (8%) in G1 vs. 458 (24.5%) in G2 (<it>P </it>< 0.0001). Recirculation in A was 10.0% (Inter quartile rank, IQR 6.5, 14.2) in G1 vs. 9.8% (IQR 7.5, 14.1) in G2 (<it>P </it>= 0.62). IK in A was 214 ± 34 (G1) vs. 213 ± 35 (G2) (<it>P </it>= 0.65). IK Anova between G2 zones was: A vs. C and D (<it>P </it>< 0.000001). Staff prescription adherence was 81.3% (G1) vs. 84.1% (G2) (<it>P </it>= 0.02).</p> <p>Conclusion</p> <p>In conclusion, an optimal Qb can de prescribed with DALP of -200 mmHg. Staff adherence to DLAP treatment prescription could be reached up to 81.3% in catheters and 84.1% in AV fistulae.</p>