Pre-dialysis application of the glucose infusion test for recirculation detection

Cinzia Libori, M. Spallazzi, M. Bono, C. Brozzo, M. Celsi, S. Grisanti, B. Iaria, D. Pellegrotti, D. Pensierini, A. Magnasco

Research output: Contribution to journalArticlepeer-review

Abstract

Vascular access recirculation (R) is a well-known cause of decreased dialysis dose. In this paper a new easy protocol for R detection in pre-dialysis derived from the classic Glucose Infusion Test (GIT) is introduced. The pre-dialysis GIT (GIT-pre) is based on the glucose (5%, 10 ml) bolus injection directly into the venous needle and on a simultaneous withdrawal from the arterial needle. If the glucose value increases during the glucose bolus, R is present. This new protocol was validated on 29 chronic haemodialysis patients (20 AVFs, 7 CVCs, 2 PTFE grafts), comparing the glucose increase with the classic GIT during dialysis. Only one CVC had R with the blood lines in the normal position (Aglu = 465 mg/dl with GIT-pre and a Δglu = 186 mg/dl, R = 9.3% with classic GIT) while in the reverse blood line position, all CVCs showed a significant glucose increase (mean GIT-pre Δglu = 195 mg/dl; mean GIT Δglu = 140 mg/dl corresponding to a R = 8%). There were 5 AVFs with true R (correct blood lines position) clearly identified by both methods (mean values Δglu = 316 mg/dl with GIT-pre and a Δglu = 390 mg/dl, R = 19.5% with classic GIT). Preliminary results show good reliability of the new protocol in identifying VA R caused either by failing VA with stenosis or by reverse blood lines position. The GIT-pre is a simpler application of the classic GIT useful for testing new VA, new needle positions or CVC performance before starting dialysis. A simpler R test could increase the frequency of the measurements and consequently the power of R in early detection of VA problems.

Original languageEnglish
Pages (from-to)191-193
Number of pages3
JournalEDTNA-ERCA Journal
Volume31
Issue number4
Publication statusPublished - Oct 2005

Keywords

  • Glucose Infusion Test
  • Recirculation
  • Vascular access

ASJC Scopus subject areas

  • Nephrology

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