Besarab A, Ross R, Effendi A, Frinak S
The relation of recirculation to access flow
Am Soc Nephrol
J Am Soc Nephrol (abstract) (Nov) 6:482 1995

This study correlated access flow measured by brachial artery Doppler with recirculation by the urea technique. In 63 patients brachial artery flow was > 450 ml/min, and these had no recirculation (mean 0.5%). In 14 patients, brachial artery flow was < 450 ml/min, and recirc increased progressively as brachial artery flow decreased (r=0.79). Recirc seemed to occur when BA flow was 60 ml higher than blood pump flow. 60 ml/min is approximately equal to the nutrient flow in the arm.

Comment: This data suggests that a severe reduction in access flow need to be present for recirculation to occur (assuming needles are not placed too close and are not reversed). (Daugirdas)

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Am Soc Nephrol
Basic hemodialysis : Vascular Access: graft/fistula