천자 방향이 혈액투석 환자의 재순환율 및 투석 적절도에 미치는 효과
Comparison of Recirculation and Dialysis Adequacy between Antegrade and Retrograde Cannulations for Hemodialysis
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Abstract
Purpose: As a cannulation method in hemodialysis (HD) patients having arteriovenous fistula (AVF), retrograde direction (opposite direction between arterial and venous cannulations) is preferred and antegrade direction (same direction) is not commonly used because of the probability of recirculation and subsequent decreased dialysis adequacy. Antegrade cannulation has longer segment for cannulation and was more comfortable and less painful, compared to retrograde cannulation. This study was performed to compare recirculation and dialysis adequacy between antegrade and retrograde cannulations in hemodialysis patients. Methods: This study enrolled 36 chronic renal failure patients who received HD 3 times a week for more than 3 months through AVF. We performed hemodialysis with retrograde cannulation for 4 weeks and then switched it to antegrade cannulation. We compared recirculation ratio and dialysis adequacy between the two cannulation methods. AVF blood flow and recirculation ratio were measured by ultrasonic dilution method and Kt/V was measured by using single pool urea kinetics model. Results: The length between arterial and venous needle tips was shorter in antegrade cannulation than retrograde cannulation(7.8±3.5cm vs. 10.20±3.30cm, p<.00). Recirculation did not occur in both cannulation methods. There was no difference in Kt/V between both cannulation methods(1.43±0.14 vs. 1.46±0.19, p=.067). Conclusion: Although the length between arterial and venous needle tips is shorter in antegrade cannulation than retrograde cannulation, both cannulation methods do not make recirculation in HD patients with well-functioned AVF. And there is no difference in dialysis adequacy between the two methods.
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