Glucose infusion test: A new screening test for vascular access recirculation

Alberto Magnasco, Sandro Alloatti, Giovanna Bonfant, Francesco Copello, Paolo Solari

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)2123-2128
Number of pages6
JournalKidney International
Volume57
Issue number5
DOIs
Publication statusPublished - 2000

Fingerprint

Blood Vessels
Urea
Glucose
Limit of Detection
Dialysis
Renal Dialysis
Blood Glucose
Confidence Intervals
Costs and Cost Analysis

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 journalArticle

Magnasco, Alberto ; Alloatti, Sandro ; Bonfant, Giovanna ; Copello, Francesco ; Solari, Paolo. / Glucose infusion test : A new screening test for vascular access recirculation. In: Kidney International. 2000 ; Vol. 57, No. 5. pp. 2123-2128.
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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.",
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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.

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