Abstract
Background. Vascular access recirculation is an important cause of diminished dialysis efficiency. We propose a new screening test based on glucose infusion as a tracer for recirculation. Methods. The glucose infusion test (GIT) protocol comprises a basal blood sample (A) from the arterial port, a 5 mL bolus of 20% glucose into the venous chamber (time 0), followed by a second sample (B) in four seconds (from 13 to 17 s with Q(B) 300 mL/min) from the same port. The blood glucose level is determined at the bedside on A and B with a reflectance photometer (CV 1.8%). Interpretation of the test is straightforward: If B = A, there is no recirculation, whereas if B > A, recirculation can be calculated from the regression equation: 0.046 X (B - A) + 0.07, obtained from in vitro tests reproducing artificial recirculation at 0, 5, and 10%. To validate this new method in vivo, we compared GIT and the urea test on 39 hemodialysis patients, obtaining a good correlation (r = 0.93). The two tests were considered positive (recirculation present) when the lower 95% confidence intervals were more than zero. Results. Our patients were divided into two groups: those with (22 out of 39, mean recirculation 11.8%) or without recirculation (17 out of 39, mean 0.06%). The urea test did not recognize 7 out of 22 patients because they had a small recirculation below the urea test limit of detection. Conclusions. GIT was more sensitive (detection limit 0.3%), simpler, and immediate in showing the results than the urea test. It is an accurate and low-cost technique for screening and follow-up of vascular access in a dialysis unit.
| Original language | English |
|---|---|
| Pages (from-to) | 2123-2128 |
| Number of pages | 6 |
| Journal | Kidney International |
| Volume | 57 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2000 |
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Keywords
- Cardiopulmonary recirculation
- Dialysis efficiency
- Urea test
- Vascular access
ASJC Scopus subject areas
- Nephrology
Cite this
Glucose infusion test : A new screening test for vascular access recirculation. / Magnasco, Alberto; Alloatti, Sandro; Bonfant, Giovanna; Copello, Francesco; Solari, Paolo.
In: Kidney International, Vol. 57, No. 5, 2000, p. 2123-2128.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Glucose infusion test
T2 - A new screening test for vascular access recirculation
AU - Magnasco, Alberto
AU - Alloatti, Sandro
AU - Bonfant, Giovanna
AU - Copello, Francesco
AU - Solari, Paolo
PY - 2000
Y1 - 2000
N2 - Background. Vascular access recirculation is an important cause of diminished dialysis efficiency. We propose a new screening test based on glucose infusion as a tracer for recirculation. Methods. The glucose infusion test (GIT) protocol comprises a basal blood sample (A) from the arterial port, a 5 mL bolus of 20% glucose into the venous chamber (time 0), followed by a second sample (B) in four seconds (from 13 to 17 s with Q(B) 300 mL/min) from the same port. The blood glucose level is determined at the bedside on A and B with a reflectance photometer (CV 1.8%). Interpretation of the test is straightforward: If B = A, there is no recirculation, whereas if B > A, recirculation can be calculated from the regression equation: 0.046 X (B - A) + 0.07, obtained from in vitro tests reproducing artificial recirculation at 0, 5, and 10%. To validate this new method in vivo, we compared GIT and the urea test on 39 hemodialysis patients, obtaining a good correlation (r = 0.93). The two tests were considered positive (recirculation present) when the lower 95% confidence intervals were more than zero. Results. Our patients were divided into two groups: those with (22 out of 39, mean recirculation 11.8%) or without recirculation (17 out of 39, mean 0.06%). The urea test did not recognize 7 out of 22 patients because they had a small recirculation below the urea test limit of detection. Conclusions. GIT was more sensitive (detection limit 0.3%), simpler, and immediate in showing the results than the urea test. It is an accurate and low-cost technique for screening and follow-up of vascular access in a dialysis unit.
AB - Background. Vascular access recirculation is an important cause of diminished dialysis efficiency. We propose a new screening test based on glucose infusion as a tracer for recirculation. Methods. The glucose infusion test (GIT) protocol comprises a basal blood sample (A) from the arterial port, a 5 mL bolus of 20% glucose into the venous chamber (time 0), followed by a second sample (B) in four seconds (from 13 to 17 s with Q(B) 300 mL/min) from the same port. The blood glucose level is determined at the bedside on A and B with a reflectance photometer (CV 1.8%). Interpretation of the test is straightforward: If B = A, there is no recirculation, whereas if B > A, recirculation can be calculated from the regression equation: 0.046 X (B - A) + 0.07, obtained from in vitro tests reproducing artificial recirculation at 0, 5, and 10%. To validate this new method in vivo, we compared GIT and the urea test on 39 hemodialysis patients, obtaining a good correlation (r = 0.93). The two tests were considered positive (recirculation present) when the lower 95% confidence intervals were more than zero. Results. Our patients were divided into two groups: those with (22 out of 39, mean recirculation 11.8%) or without recirculation (17 out of 39, mean 0.06%). The urea test did not recognize 7 out of 22 patients because they had a small recirculation below the urea test limit of detection. Conclusions. GIT was more sensitive (detection limit 0.3%), simpler, and immediate in showing the results than the urea test. It is an accurate and low-cost technique for screening and follow-up of vascular access in a dialysis unit.
KW - Cardiopulmonary recirculation
KW - Dialysis efficiency
KW - Urea test
KW - Vascular access
UR - http://www.scopus.com/inward/record.url?scp=0034099470&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034099470&partnerID=8YFLogxK
U2 - 10.1046/j.1523-1755.2000.00063.x
DO - 10.1046/j.1523-1755.2000.00063.x
M3 - Article
C2 - 10792633
AN - SCOPUS:0034099470
VL - 57
SP - 2123
EP - 2128
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 5
ER -