Discussion Different Vascular On Dialysis Adequacy In Hemodialysis Patients

Objective: Recirculation（Ret%）,urea reduction ratio（URR）and Kt/V of hemodialysispatients are determined in two different vascular access,such as central venous catheter andautogenous arteriovenous fistula,the objective is to evaluate the size and have the impact ondialysis adequacy.Methods:(1)Select maintenance hemodialysis patients with80cases in our center, Centralvenous catheter(CVC) group with40cases and Autologous arteriovenous fistula(AVF) groupwith40cases were as research subjects. In the CVC group, there are27cases of male and13cases of females, with average ages of54.4±15.2years and the dialysis’ages of30.2±25.2months; In the AVF group,there are30cases of males and10cases of females, with averageages of48.6±14.1years and the dialysis’ages of40.2±22.6months;(2)Dialysis blood flowvelocity250ml/min,dialysate flow500ml/min, dialysis treatment three times a week,fourhours at a time, and using the F7dialyzers are asked;(3) The glucose injection test(GIT)measureds tests and calculates the Ret%: After dialysis30min,the blood pump speed is300ml/min, stop ultrafiltration, withdraw arterial blood (0.1ml), and determine blood glucoseby using blood glucose meter, the value is recorded as C1(mg/dl). Start the timer and inject abolus of20%glucose into the venous drip chamber in four seconds [if50%glucose is notavailable, the same glucose dose (1g of glucose in5mL) can be prepared diluting2mL of50%glucose with3mL saline]. At the13th second, withdraw approximately0.1mL of bloodfrom the same port during four seconds (from13to17s),.Determining the value is recordedas C2(mg/dl). If C2> C1, the use of the formula, R1=0.046(C2-C1)+0.07, calculating therecirculation rate (R1), R1>0.3exception; if C2≤C1, then there is no recirculation.(4)withdraw and calculate URR and Kt/V: withdraw arterial blood without heparin and salinebefore dialysis; The end of dialysis, stop ultrafiltration, reduce the speed of the blood pump to100ml/min for15seconds, withdraw blood from the arterial end. Respectively apply theformula URR (%)=100(1-after dialysis urea/dialysis urea before) and Kt/V=-Ln(R2-0.008t)+(4-3.5R2)×UF/W to calculat values.Results:⑴Respectively compared with gender,age,dialysis months between the CVC groopand the AVF group,the difference was not statistically significant(P>0.05).⑵The CVC groopand the AVF groop, the two groups’pathway recycling rates were32.5%and22.5%,respectively, the difference was not statistically significant (χ2=1.003,P>0.05).13cases ofcatheter group compared with9cases of fistula group,the pathway recycling value of Centralvenous catheter group is greater than that of the fistula group（1.446±1.195VS0.447±0.161）,respectively, the difference was statistically significant (P<0.05).⑶Compared with Ureareduction value between CVC groop and the AVF group,the difference was not statisticallysignificant（68.01±9.17VS70.25±7.59,P>0.05）.⑷Compared with Kt/V value between CVCgroop and the AVF group,the difference was not statistically significant(0.986±0.229VS1.023±0.24，P>0.05).⑸Compared with the correlation between URR and Kt/V,the resultsis showed as a significant positive correlation.The presence of URR and Kt/V is closely, andthe relationship is showed as the curvilinear.⑹Compared with URR value in the two groups of recirculation and no recirculation,the difference was not statistically significan（68.10±8.71VS69.52±8.38,P>0.05）.⑺C ompared with Kt/V value in the two groups ofrecirculation and no recirculation,the difference was not statistically significan（1.02±0.25VS0.99±0.23,P>0.05）.Conclusions: Application of CVC and AVF has no differences of dialysis adequacy. Basedon the actual situation of different patients, the clinician should use different dialysis vascularaccess.