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Introduction: Catheter dysfunction is a concern when using double-lumen catheters in hemodialysis (HD). Reversing the connection mode results in higher blood flows, but also enhanced recirculation. We evaluated total solute removal (TSR) of different uremic retention solutes during a complete HD session, once with reversed (RL) and once with correctly connected lines (CL). Methods: Genius dialysis was performed in 22 HD patients at maximum blood flow (QB), once with CL and once with RL. TSR was determined for urea, creatinine, phosphate and ß2-microglobulin (ß2M). Using a kinetic model, we simulated TSR and reduction ratio (RR) for urea for different percentages of access recirculation and different QB during CL vs. RL. Results: RR and TSR of the tested solutes were not different in clinical practice between CL and RL. Mathematically, urea RR did not differ with CL or RL, but TSR decreased by 4.5%-23.3% when changing from CL to RL for a recirculation of 5%-25%, respectively. For a recirculation of 5%-25%, QB in RL should be increased by 6.7% and 52.0%, 8.5% and 72.0%, and 10.0% and 115.2%, respectively, for a blood flow in CL mode of 150, 200 or 250 ml/min. Conclusions: Connecting patients to double-lumen dialysis catheters in RL does not impair TSR in clinical practice. Mathematically, TSR during RL was dependent upon the obtained QB and degree of recirculation. A nomogram indicating the increase in QB needed in RL to obtain equal TSR as in the CL mode, at different degrees of recirculation, is provided.
Renal Division, Ghent University Hospital, Ghent - Belgium.
This article was published in the following journal.
Name: Journal of nephrology
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Gene rearrangement of the B-lymphocyte which results in a substitution in the type of heavy-chain constant region that is expressed. This allows the effector response to change while the antigen binding specificity (variable region) remains the same. The majority of class switching occurs by a DNA recombination event but it also can take place at the level of RNA processing.
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RNA consisting of two strands as opposed to the more prevalent single-stranded RNA. Most of the double-stranded segments are formed from transcription of DNA by intramolecular base-pairing of inverted complementary sequences separated by a single-stranded loop. Some double-stranded segments of RNA are normal in all organisms.
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