Learn about blood flow rates in dialysis as they relate to health and viability of the fistula and dialysis patient mortality. Examine how blood and dialysate flow rates impact dialysis clearance.
Describe the key elements of an arteriovenous fistula (AVF).
• AVF sites • AVF options, including size, angle, and curvature, to minimize turbulence
Review the interaction between blood flow rate, turbulence, vibratory harmonics, and stenosis.
• Describe turbulence and give example • Effect of turbulence on endothelial cells, increasing risk of stenosis • Increased blood flow rates equate to increased turbulence • Describe vibratory harmonics and give example • Effect of vibratory dysharmony on endothelial cells, increasing risk of stenosis
Discuss how stenosis impacts blood flow through the AVF.
• Most common sites of stenosis in AVF, arterial and venous • Inflow vs. outflow stenosis • Increased blood flow increases both turbulence and vibratory harmonics
Identify how blood flow rate may impact dialysis adequacy.
• DOPPS data show international and regional differences in dialysis blood flow rates • DOPPS data show increased mortality rates corresponding with increased blood flow rates • Clearance increases with higher blood flows until about 300-325 mL/min, then levels off
Author Information
Dr. John Agar Dr. John Agar has over 50 years of experience, over 30 of those years as a Senior Physician of Nephrology at Geelong Hospital in Australia. He is an internationally-recognized award-winning nephrologist with over 200 peer-reviewed journal articles and abstracts.
Provider approved by the California Board of Registered Nursing, Provider Number 17088, for 1.25 contact hours
