Improving the Efficiency of Short-Term Single-Needle Hemodialysis

Abstract

It is widely believed that single-needle (SN) hemodialysis is inferior to conventional double-needle (DN) hemodialysis. The purpose of this study was to compare two SN dialysis regimens using different blood flow rates with conventional DN hemodialysis. The primary outcome measure was ionic dialysance. We studied eight patients (two women, six men) undergoing chronic intermittent DN bicarbonate hemodialysis three times per week on a Cimino-Brescia fistula for at least three months. The study had a prospective four-period design and lasted four weeks. During weeks 1 and 3, the participants had standard DN hemodialysis sessions, with Wallace needles at a blood flow rate of 250-300 mL/min. During week 2, they had single-needle dialysis sessions with a short 15-gauge stainless-steel needle, an effective blood flow rate of 180 mL/min (360 mL/min for each of the two pumps), and venous pressure below 200 mmHg. During week 4, they had SN dialysis sessions with a short 15-gauge stainless-steel needle, an effective blood flow rate of 250 mL/min (500 mL/min for each of the two pumps), and a venous pressure below 200 mmHg. Ionic dialysance recorded 45 minutes after the beginning of the dialysis session and 30 minutes before the end of the session were used for statistical analysis. The effective blood flow target of 250 mL/min was achieved in six of the eight patients. Ionic dialysance 45 minutes after the beginning of the session differed among the four periods (p < 0.001, Friedman test). Ionic dialysance was better during each DN dialysis period than during the 180 mL/min SN period (p < 0.01, Dunn's multiple comparison tests), but there was no difference with the 250 mL/min SN period. Ionic dialysance 30 minutes before the end of the dialysis session differed among the four periods (p < 0.001, Friedman test). Ionic dialysance was far better during each DN period than during the 180 mL/min SN period (p < 0.001, Dunn's multiple comparison test) and slightly better than during the 250 mL/min SN period (p < 0.05, Dunn's multiple comparison test). The single-pool Kt/V ratio differed among the four periods (p < 0.0001, Friedman test). The Kt/V ratios were far better during each DN period than during the 180 mL/min SN period (p < 0.001, Dunn's multiple comparison test) and slightly better than during the 250 mL/min SN period (p < 0.01, Dunn's multiple comparison test). The Kt/v provided by the dialysis monitor gave identical results to single pool Kt/v. We conclude that single-needle dialysis with an effective blood flow rate of 180 mL/min delivers an inadequate dialysis dose, which may be harmful. In contrast, an effective blood flow rate of 250 mL/min appears acceptable for brief periods of single-needle dialysis lasting one or two weeks. Otherwise, an increase in the length of the dialysis session and/or the use of a larger membrane surface area and even higher blood flow is required to obtain the same quality of dialysis as with conventional double-needle hemodialysis. Careful monitoring of the dialysis dose delivered is mand...

Single Needle Granulocyte and Monocyte Apheresis for Ulcerative Colitis: A Retrospective Safety Analysis

“…Hemodialysis patients were treated using the SN technique for the following reasons: to decrease the risk of early arteriovenous fistula failure, to facilitate cannulation for nurses, and to reduce the pain burden for the patient [13][14][15]. However, the use of SN dialysis is mainly limited by the inadequacy of treatment due to lower blood flow, higher recirculation, and shorter treatment time with suboptimal amount of cleared blood volume and low KT/V [11,16]. Recently, several studies have demonstrated comparable effects of SN hemodialysis and DN hemodialysis in patients with chronic kidney disease without any adverse effects [10,11].…”

Effectiveness of a New Single‐Needle Single‐Pump Dialysis System with Simultaneous Monitoring of Dialysis Dose

“…In 1979, 8% in Europe and 60% of the hemodialysis patients in Belgium were treated with the single‐needle technique for several reasons: to decrease the risk of an early AVF failure , to facilitate cannulation for nurses, and to reduce the burden of pain for the patient. However, the single‐needle dialysis approach was mainly limited by inadequacy of the treatment due to lower blood flow, higher recirculation and shortened treatment time (caused by the biphasic circulation) with a suboptimal amount of cleared blood volume and low Kt / V , respectively. Moving from double to single‐needle dialysis, the increase of treatment time by about 30 min as demonstrated by Trakarnvanich et al is the only valid option to maintain the adequacy.…”

Single-Needle Hemodialysis on Native Fistulae

“…Few data are available on short-term SN dialysis and especialy on the dialysis dose measured using a reliable method. Four publications have clearly shown that the technique of hemodialysis in unipuncture delivered an insufficient dose of dialysis [15][16][17][18], which fell below the recommendations of the EDTA and KDOQI [19][20]. These four publications quantified the dose of dialysis by the single-pool Kt/V [15][16][17][18] and the most recent also studied the ionic dialysance and the Kt/V provided by the dialysis monitor [18].…”

“…Four publications have clearly shown that the technique of hemodialysis in unipuncture delivered an insufficient dose of dialysis [15][16][17][18], which fell below the recommendations of the EDTA and KDOQI [19][20]. These four publications quantified the dose of dialysis by the single-pool Kt/V [15][16][17][18] and the most recent also studied the ionic dialysance and the Kt/V provided by the dialysis monitor [18]. Wright and coworkers in the year 2000, were the first to draw attention to the importance of the method of blood sampling in relation to the circuit of unipuncture for the determination of post-dialysis urea in the singlepool method and the risk of a "dramatically optimistic" overestimation of the single-pool Kt/V (due to the contamination of the arterial blood by the recently dialysed venous blood) : among their five patients in SN dialysis, the mean Kt/V taken without precautions measured 1.7 instead of a real value of 1 [15,21].…”