Blood Flow, dialysate flow & fistula life?

Hi all, just a query. I’ve dialysed for a long time with a blood flow (pump speed) of 350. Usually processing a total of 84 litres.

My nurse suggested turning down the blood flow to 300 but increasing the dialysate flow from 500 to 600. This means I get less litres processed, but is apparently better for my fistula. (May even be better for my heart, not sure what he said exactly.)

With the reduced setup the litres processed is understandably less.

Any ideas/suggestions. I’m going to bring it up at my next appointment. Just curious.

I would love it if someone could give me a factual answer to this question, too. Pro. Agar- any info on this? I have heard that in European units they run low BFR’s of around 300, but they also run longer txs of around 5 hrs. Don’t recall what they do re the DFR. The Europeans ( not sure what countries take this approach) don’t subscribe to the “speed dialysis” that we have in the USA. Have been on the boards nearly a decade now and have never seen a good answer to this question, although surely someone in Dialysis Land must know the answer to this question.

The entire time I was in-center I ran at a 350 BFR. My heart and access could not handle a higher rate then that and I got good clearances doing 4 hr txs with a DFR of 800. I was only asked to run 3 1/2 , but I chose to run 4 until I could get into a home program. Sadly, it took me many yrs to get into a home program. But now that I am on NxStage, I am running at 450 as the machine does not affect me like the large in-center machines did. Nevertheless, yours is an essential question and I would be thrilled if someone finally provided an educated, factual answer to it.

Excellent question, Jane & JW. There has been less research into this question than you might think, but I heard Dr. Zbylut Twardowski, MD, PhD, give a presentation on catheters (and catheter rates in the US) at the ADC meeting a couple of years ago. He said that fistulas that are acceptable in Japan and Australia and Canada and Europe with blood flow rates of 200-300 are NOT acceptable here in the US, where we typically run folks at 450-500 with our shorter treatments. So, there are many more “successful” fistulas there than here. Dr. Twardowski is one of my gurus–he knows dialysis down to the ground, and I’ve never known him to be wrong.

Here’s a brand new abstract out of Serbia that suggests some very disturbing links between high blood flow rates during dialysis and high blood pressure inside the heart that can lead to LVH (left ventricular hypertrophy–the leading reason for heart failure in dialysis):

Med Pregl. 2007 Mar-Apr;60(3-4):183-6.
[Vascular access blood flow for hemodialysis–a risk factor for development of cardiovascular complications in hemodialysis patients]
[Article in Serbian]

Petrovi? D, Stojimirovi? B.
Klinika za urologiju i nefrologiju, Odeljenje hemodijalize, Klinicki centar Kragujevac. aca96@Eunet.yu

INTRODUCTION: Vascular access blood flow rate of 100-350 cm/s and between 500 and 1000 ml/min, points to normal vascular access function and adequate hemodialysis. High blood flow through the arteriovenus fistula overloads the left ventricle inducing left ventricular remodiling. MATERIAL AND METHODS: The aim of the study was to establish the degree of correlation between blood flow through the vascular access for hemodialysis and echocardiographic parameters for the assessment of left ventricular hypertrophy and left ventricular dilatation and left ventricular function. The research included 115 patients (M:F 71:44), average age 53.30+/-12.17 years, average length of dialysis 4.51 +/- 4.01 years and average Kt/Vsp index 1.17+/-0.23. RESULTS: The average blood flow through the vascular access for hemodialysis was 662.27+/-301.59 ml/min. EDDLV 54.52+/-6.42 mm, and EDVi 100.80+/-34.62 ml/m2. There is a statistically significant positive correlation between blood flow through vascular access for hemodialysis and EDDLV and EDVi. CONCLUSION: High blood flow through the vascular access for hemodialysis is an independent risk factor for the development of cardiovascular complications in patients on hemodialysis.

Guess the reason for Nocturnal is the low blood flow rate. It is gentle and easier on your body… We have been using a blood flow rate of 200 for about 7 years. It was 200 on the Fresenius and now 200 on the NxStage… Process aprox 84 ltrs/Tx. (200 X 60 =12000 divided by 1000= 12 (this converts 200 ml/minute to ltr per hr) 12 ltr X 7 hr = 84 ltr/hr during our training for nocturnal we were told that 200 is the max we can set the blood flow rate. So think the lower flow rate is easier on the body… When we had to go to incenter treatments because of machine problems, we had problems getting and keeping the machine running with a blood flow of 350… (using a cathater)constant alarmed and had to reduce it down to 300…
Guess the only way to check out the lower blood flow rate is to try it and have your blood drawn and have the results compared to the highte blood flow rate…I think, By having a lower blood flow rate and a higher dialysate flow rate the results should be the same as long as the time remain constant. The higher dialysate rate should remove more toxins from the blood. But as you mentioned you had problems when in center with a high dialysate flow rate of 800. Looking over our training material for Nocturnal The program chose 300ml/minute dialysate flow rate as this will allow for a slower and more gentle dialysis.

HemoHelper

Indeed it will be checked next time I have monthly bloods, usually done at my unit on the second Thursday of the month.