Recirculation: Review, Techniques for Measurement and Ability to Predict Hemoaccess Stenosis before and after Angioplasty

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Abstract
The measurement of recirculation during two-needle hemodialysis has been shown to provide valuable information concerning distal hemoaccess stenosis and the loss of effective dialysis. Reference sources have suggested that levels of recirculation above 20% call for further investigation. We proposed a technique for routine recirculation measurement and studied 20 stable hemodialysis patients using this method. We found that all patients had recirculations of less than 10%. We also studied 2 patients with angiographically proven stenosis and found 1 patient with a recirculation of less than 20%.Routine recirculation testing provides valuable information about hemoaccess integrity and using our techniques, recirculation greater than 10% is an indication for further study.

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