Access recirculation and adequacy of hemodialysis in different types of vascular access

Haemodialysis requires recirculation, and it happens when dialysed blood returningthrough the venous needle re-enters the extracorporeal circuit through the arterial needle, ratherthan returning to the systemic circulation. Significant recirculation should be expected, when there isan inadequate reduction in the values of urea. During End-Stage Renal Disease (ESRD), adequatedialysis is of utmost importance because it influences the morbidity and mortality of the patients.Methods and materials: The study was carried out in 200 patients who underwent haemodialysisat the dialysis unit in Kalyani kidney care centre, Erode. Patients were actively evaluated fromFebruary 2018 till November 2018. Patients were randomized and accordingly 64 patients wereenrolled in category I Arteriovenous fistula (AVF), 63 Patients in category II Internal JugularCatheter (IJC) and category III Femoral Catheter (FC) each and 10 patients in category IV PermCatheter (PC). Success recirculation was estimated and adequacy of haemodialysis was donevirtually. Calculated Kt/V was done in almost all patients. Results: The mean access recirculationrate was 6.3+5.1% in those with AVF, while in IJC and FC groups were 6.7+4.5% and 24.4+11.7%respectively. When the two groups were compared, AVF vs FC groups, the difference was statisticallysignificant (p value<0.001) and in IJC vs FC groups, the difference was statistically less significant(p-value <0.001) in both AR% and online Kt/V. Conclusion: An arteriovenous2QQ2 fistula has lessaccess recirculation, when compared to temporary catheters. On the other hand, the femoralcatheter has more access recirculation, when compared to the internal jugular catheter. Thedifference in calculated Kt/V with the three types of vascular access has no statistical significance.